What Is Nuedexta? Uses, Dosage, and What You Need to Know in 2026

Nuedexta is a prescription medication that treats pseudobulbar affect (PBA) — a neurological condition causing uncontrollable, involuntary outbursts of laughing or crying. It is the only medication specifically approved by the FDA for this purpose. This guide covers everything you need to know about Nuedexta: what it is, what it treats, how it works, how to take it, and what to expect.

What Is Nuedexta?

Nuedexta is a fixed-dose combination capsule containing two active ingredients:

Dextromethorphan hydrobromide (DM) — 20 mg: The active therapeutic ingredient. It is a sigma-1 receptor agonist and NMDA receptor antagonist that acts on the central nervous system.

Quinidine sulfate — 10 mg: Not a therapeutic agent for PBA on its own. Quinidine's role is to inhibit the CYP2D6 enzyme that rapidly breaks down dextromethorphan, increasing its bioavailability approximately 20-fold.

Nuedexta was developed by Avanir Pharmaceuticals (now a subsidiary of Otsuka) and received FDA approval in October 2010. It has been prescribed to more than 200,000 patients by over 80,000 physicians.

What Does Nuedexta Treat?

Nuedexta is FDA-approved for the treatment of pseudobulbar affect (PBA). PBA is a neurological condition characterized by sudden, involuntary, and frequent episodes of laughing and/or crying that are disproportionate to or incongruent with the patient's underlying emotional state.

PBA occurs secondary to various neurological conditions and injuries, including:

Amyotrophic lateral sclerosis (ALS) — PBA prevalence is approximately 50% in ALS patients

Multiple sclerosis (MS)

Stroke

Traumatic brain injury (TBI)

Parkinson's disease

Alzheimer's disease

Importantly, PBA is distinct from primary depression or anxiety. A patient experiencing PBA may burst into tears while watching a happy movie, or laugh uncontrollably in a situation that is not funny — and have no ability to control it. This involuntary quality is the hallmark of the condition.

How Do You Take Nuedexta?

Nuedexta comes as an oral capsule taken by mouth. The dosing schedule is:

Starting dose (Week 1): One capsule once daily for 7 days

Maintenance dose (after 7 days): One capsule every 12 hours (twice daily)

Maximum daily dose: Two capsules per 24 hours (40 mg DM / 20 mg quinidine)

Nuedexta can be taken with or without food. Take doses approximately 12 hours apart. Do not take a double dose if you miss one. Do not exceed two capsules in 24 hours.

Is Nuedexta a Controlled Substance?

No. Nuedexta is not a controlled substance and is not scheduled by the DEA. It can be prescribed by any licensed physician, NP, or PA; transmitted electronically; and filled at any retail or specialty pharmacy without controlled substance restrictions.

How Much Does Nuedexta Cost?

Nuedexta is available only as a brand-name medication. The retail cash price is approximately $1,545 for 60 capsules (a 30-day supply). However, several programs can reduce this cost significantly:

Manufacturer co-pay card: As little as $0 for 90-day supply (commercially insured patients)

Otsuka Patient Assistance Foundation: Free medication for eligible uninsured/underinsured patients

GoodRx/SingleCare coupons: Reduce cost at participating pharmacies (prices vary)

How Effective Is Nuedexta?

FDA approval for Nuedexta was based on three double-blind, multicenter clinical trials. The pivotal trial of 326 ALS and MS patients demonstrated significant reductions in PBA episode frequency and severity compared to placebo, as measured by the CNS-Lability Scale (CNS-LS). Patients in clinical trials experienced meaningful reductions in the number and intensity of PBA episodes, with most seeing noticeable improvement within the first few weeks.

To learn how Nuedexta works, see our guide on how Nuedexta works. For details on what side effects to expect, read our article on Nuedexta side effects.