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This document provides essential safety information for those considering or currently using Nuedexta (dextromethorphan/quinidine). It is crucial to understand the associated risks and precautions. Please consult your healthcare provider for any personal concerns or questions.

• Allergic Reactions and Low Platelets: There is a risk of severe allergic reactions with Nuedexta, especially if you have previously reacted to quinine or mefloquine. Such reactions may lead to low platelet levels (thrombocytopenia), which can cause symptoms like lightheadedness, fever, chills, nausea, and vomiting. In rare cases, it can result in uncontrollable bleeding.

• Liver Damage: Nuedexta may cause liver inflammation or damage, typically occurring in the initial weeks of treatment and resolving once the medication is discontinued. Watch for symptoms such as fever, tiredness, nausea, stomach pain, or yellowing of the skin and eyes, and seek medical advice if these occur.

• Abnormal Heart Rhythm: The medication can cause QT prolongation, a condition affecting heart rhythm. This risk increases with factors like low electrolyte levels, existing heart issues, or other medications that influence heart rhythm (e.g., amiodarone, quetiapine). Immediate medical attention is required if you experience chest pain, shortness of breath, or severe dizziness.

• Dizziness: Nuedexta may induce dizziness, increasing the risk of falls. To minimize this risk, avoid alcohol and rise slowly from sitting. This is particularly important for those with a history of falls.

• Serotonin Syndrome: This serious condition can occur if Nuedexta is combined with drugs affecting serotonin levels, such as certain antidepressants and migraine medications. Inform your healthcare provider about all medications you take to avoid interactions. Symptoms include rapid heart rate, sweating, muscle stiffness, high fever, and confusion, requiring urgent medical attention.

Contraindications: You should not use Nuedexta if you have:

• A history of allergic reactions, hepatitis, or low platelets from quinidine, quinine, or mefloquine.
• Certain heart conditions like heart failure, QT prolongation, or AV block without a pacemaker.
• Taken quinine, quinidine, mefloquine, or any medications causing QT prolongation.
• Used a monoamine oxidase inhibitor (MAOI) within the last 14 days.

For any of these conditions, consult with your healthcare provider before starting Nuedexta to ensure it is safe for you.

When taking this medication, some people may experience common side effects such as diarrhea, dizziness, cough, vomiting, weakness, and swelling in the hands, ankles, or feet. These effects are generally mild, but if they persist or worsen, it is advisable to consult a healthcare provider.

In addition to these common side effects, some individuals might encounter other less frequent issues like bladder infections, flu-like symptoms, or passing gas. While these are usually not serious, if they cause concern, talking to a healthcare professional is recommended.

There are rare but serious side effects that require immediate medical attention. These include signs of low platelets, such as easy bruising, unusual bleeding, or purple/red spots on the skin. Liver damage is another serious concern, indicated by severe stomach pain, yellowing of the skin or eyes, and loss of appetite. Abnormal heart rhythms, known as QT prolongation, may manifest as chest pain, shortness of breath, or feeling faint. Serotonin syndrome is a very serious condition that may occur, characterized by fast heartbeat, hallucinations, severe nausea, or muscle twitching. If any of these symptoms arise, urgent medical care is essential.

Although a very serious allergic reaction is rare, be alert for signs like rash, severe dizziness, or trouble breathing, and seek immediate help if they occur. Always inform your healthcare provider about all medications you are taking to mitigate any risks.

When taking Nuedexta (dextromethorphan/quinidine), it is important to be aware of potential interactions with other medications or supplements you may be using. Inform your healthcare provider about all medications and supplements you take, including prescription, over-the-counter, vitamins, and herbal products.

Some drugs that should not be used with Nuedexta include Fingolimod, Propafenone, and rolapitant. This is because Nuedexta can slow the removal of certain medications from the body, potentially altering their effectiveness. Medications affected include Aliskiren, codeine, Digoxin, Mefloquine, and tricyclic antidepressants like Desipramine and imipramine.

Additionally, some medications can interfere with the elimination of quinidine from your body, impacting its effectiveness. These include cobicistat, Mifepristone, Ritonavir, and certain azole antifungals such as Fluconazole and Ketoconazole.

It's crucial to avoid MAO inhibitors while on this medication due to the risk of serious, potentially fatal interactions. MAO inhibitors include isocarboxazid, Linezolid, phenelzine, and others. Consult your doctor about when to start or stop using these medications.

Furthermore, many drugs can affect heart rhythm, a condition known as QT prolongation. Such drugs include ranolazine, certain antiarrhythmics like Amiodarone, certain antipsychotics, and some quinolone antibiotics.

Lastly, the risk of serotonin syndrome increases if you are taking other medications that elevate serotonin levels, such as SSRIs and SNRIs. Avoid using quinine products alongside quinidine to prevent adverse effects. Always consult your healthcare provider for personalized advice and adjustments to your treatment plan.