Ammonaps (sodium phenylbutyrate) vs Nuedexta (dextromethorphan HBr and quinidine sulfate)

Ammonaps (sodium phenylbutyrate) vs Nuedexta (dextromethorphan HBr and quinidine sulfate)

Ammonaps (sodium phenylbutyrate) is primarily used to treat urea cycle disorders, which are genetic conditions that affect the body's ability to remove ammonia from the bloodstream. Nuedexta (dextromethorphan HBr and quinidine sulfate), on the other hand, is approved for the treatment of pseudobulbar affect (PBA), a condition characterized by sudden and uncontrollable episodes of crying or laughing. When deciding between these two medications, it is essential to consider the specific condition being treated, as they are intended for very different medical issues and are not interchangeable.

Difference between Ammonaps and Nuedexta

Metric Ammonaps (sodium phenylbutyrate) Nuedexta (dextromethorphan HBr and quinidine sulfate)
Generic name Sodium phenylbutyrate Dextromethorphan hydrobromide and quinidine sulfate
Indications Urea cycle disorders Treatment of pseudobulbar affect (PBA)
Mechanism of action Converts to phenylacetate in vivo, which conjugates with glutamine to form phenylacetylglutamine, thereby reducing ammonia levels. Dextromethorphan acts on the central nervous system to modulate the excitatory neurotransmitter glutamate, while quinidine increases the availability of dextromethorphan by inhibiting its metabolism.
Brand names Ammonaps, Buphenyl Nuedexta
Administrative route Oral Oral
Side effects Nausea, vomiting, headache, fatigue, abnormal taste, anorexia, edema Dizziness, nausea, cough, vomiting, diarrhea, peripheral edema, urinary tract infections
Contraindications Hypersensitivity to sodium phenylbutyrate or any component of the formulation Hypersensitivity to dextromethorphan or quinidine, a history of heart failure or prolonged QT interval, use of MAOIs within the past 14 days
Drug class Urea cycle disorder agent Central nervous system agent
Manufacturer Horizon Pharma Avanir Pharmaceuticals

Efficacy

Efficacy of Ammonaps (Sodium Phenylbutyrate) in ALS

Ammonaps, known generically as sodium phenylbutyrate, is a drug that has been explored for its potential efficacy in the treatment of Amyotrophic Lateral Sclerosis (ALS), although it is not primarily indicated for this condition. ALS is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord, leading to loss of muscle control. Sodium phenylbutyrate is thought to exert a neuroprotective effect by reducing the stress on the endoplasmic reticulum in nerve cells, which is believed to be a contributing factor in the pathogenesis of ALS. However, the evidence supporting the efficacy of sodium phenylbutyrate in ALS patients is limited, and further clinical trials are necessary to establish its therapeutic role in this condition.

Efficacy of Nuedexta (Dextromethorphan HBr and Quinidine Sulfate) in ALS

Nuedexta, a combination drug consisting of dextromethorphan hydrobromide and quinidine sulfate, is approved for the treatment of pseudobulbar affect (PBA), a condition associated with various neurological disorders, including ALS. PBA is characterized by episodes of uncontrollable laughing or crying that are disproportionate or incongruent to the patient's emotional state. In the context of ALS, Nuedexta has demonstrated efficacy in reducing the frequency and severity of PBA episodes, thereby improving quality of life for patients. Clinical trials have shown that Nuedexta is effective in managing the symptoms of PBA in ALS, with a significant reduction in episode counts compared to placebo.

While the primary use of Nuedexta in ALS patients is for the management of PBA, there is ongoing research into its potential neuroprotective effects and its ability to slow down the progression of ALS. Dextromethorphan, one of the active ingredients, is an NMDA receptor antagonist and has been hypothesized to have a neuroprotective role by mitigating glutamate excitotoxicity, a process implicated in ALS pathology. However, the efficacy of Nuedexta in altering the disease course of ALS beyond the treatment of PBA is still under investigation, and current evidence is insufficient to support its use for this broader purpose.

It is important to note that while these medications have shown promise in certain aspects of ALS treatment, their use should be guided by a healthcare professional with consideration of the individual patient’s condition and in accordance with regulatory approvals. Patients with ALS should consult with their healthcare providers to understand the potential benefits and risks of using these medications and to receive appropriate medical advice tailored to their specific situation.

Regulatory Agency Approvals

Ammonaps
  • European Medical Agency (EMA), European Union
  • Food and Drug Administration (FDA), USA
  • Therapeutic Goods Administration (TGA), Australia
Nuedexta
  • Food and Drug Administration (FDA), USA

Access Ammonaps or Nuedexta today

If Ammonaps or Nuedexta are not approved or available in your country (e.g. due to supply issues), you can access them via Everyone.org.

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