Comprehensive medication guide to Nuedexta including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$20–$75 copay per 30-day fill with commercial insurance after prior authorization approval (Tier 3 or specialty tier). Manufacturer co-pay card can reduce cost to $20/30-day or $0/90-day for commercially insured patients. Medicare Part D patients are not eligible for the co-pay card; tier exceptions available.
Estimated Cash Pricing
Approximately $1,545 retail for a 30-day supply (60 capsules) of brand-name Nuedexta; no widely available FDA-approved generic for PBA. With GoodRx or SingleCare coupons, partial supplies (14 capsules) may be available for around $383.
Medfinder Findability Score
72/100
Summarize with AI
On this page
Nuedexta is a prescription combination capsule containing dextromethorphan hydrobromide (20 mg) and quinidine sulfate (10 mg). It was developed by Avanir Pharmaceuticals (a subsidiary of Otsuka) and received FDA approval in October 2010. Nuedexta is the only FDA-approved medication specifically indicated for pseudobulbar affect (PBA).
PBA is a neurological condition characterized by sudden, involuntary, and frequent episodes of uncontrollable laughing and/or crying that are disproportionate to or incongruent with the patient's underlying emotional state. It occurs secondary to neurological conditions including ALS, multiple sclerosis, stroke, traumatic brain injury, Parkinson's disease, and Alzheimer's disease. Nuedexta has been prescribed to more than 200,000 patients by over 80,000 physicians in the United States.
Nuedexta is available only as a brand-name product. The starting dose is one capsule once daily for 7 days, followed by a maintenance dose of one capsule every 12 hours (twice daily). It is not a controlled substance and can be prescribed by any licensed provider.
We have a 99% success rate finding medications, even during nationwide shortages.
Need this medication?
Nuedexta works through a two-component mechanism. Dextromethorphan (DM) is the therapeutic active ingredient — it acts as a sigma-1 receptor agonist and an uncompetitive NMDA receptor antagonist. By modulating NMDA glutamate receptor activity and sigma-1 receptor signaling in the brain, DM is thought to reduce the dysregulated emotional expression pathways that produce PBA episodes, though the exact mechanism is not fully understood.
Quinidine's role is pharmacokinetic rather than therapeutic for PBA. It is a potent CYP2D6 enzyme inhibitor that blocks the rapid liver metabolism of dextromethorphan, increasing DM's bioavailability approximately 20-fold and allowing it to reach and sustain therapeutic brain concentrations. Without quinidine, oral dextromethorphan is broken down too quickly to achieve the levels needed for PBA treatment.
Because approximately 25% of all drugs are metabolized by CYP2D6, quinidine's inhibition of this enzyme creates significant drug interaction potential. The half-life of dextromethorphan in the presence of quinidine is approximately 13 hours, supporting twice-daily dosing at maintenance.
20 mg / 10 mg — capsule
Dextromethorphan hydrobromide 20 mg / quinidine sulfate 10 mg. Starting dose: 1 capsule daily x 7 days. Maintenance: 1 capsule every 12 hours (twice daily). Max: 2 capsules/24 hours.
Nuedexta is not on the FDA's official drug shortage list as of 2026 — it is being manufactured and distributed. However, patients routinely report difficulty finding it at standard retail pharmacies. This is because Nuedexta is a specialty brand-name medication with a relatively small patient population, meaning most retail pharmacies don't maintain standing inventory. Additionally, most insurance plans require prior authorization before covering Nuedexta, creating access delays separate from availability.
Specialty pharmacies — such as CVS Specialty, Walgreens Specialty Pharmacy, and Accredo — are the most reliable access points for Nuedexta. Mail-order pharmacy is also a consistent option. The medfinder findability score for Nuedexta is 72/100, reflecting that the drug is generally available but may require routing to specialty pharmacy and proactive PA management.
To find Nuedexta in stock near you, medfinder calls pharmacies on your behalf and texts you which ones can fill your prescription — saving you hours of phone calls.
Nuedexta is not a controlled substance and carries no DEA scheduling restrictions. Any licensed prescriber in the United States with standard prescriptive authority can prescribe it. Prescribers do not need any special DEA certification beyond their standard DEA registration to prescribe Nuedexta.
Nuedexta is most commonly prescribed by:
Neurologists (most common — especially those treating ALS, MS, Parkinson's, stroke, and TBI)
Psychiatrists (particularly for differentiating PBA from mood disorders)
Physiatrists / Rehabilitation medicine physicians (especially in TBI and stroke rehabilitation settings)
Primary care physicians (PCPs) and internal medicine physicians for ongoing management
Nurse Practitioners (NPs) and Physician Assistants (PAs) with prescriptive authority
Telehealth prescribing is available for Nuedexta. Because it is not a controlled substance, it can be prescribed through telehealth video visits without DEA telehealth restrictions. Platforms such as Teladoc, MDLive, and Amwell may have neurologists or psychiatrists who can evaluate and prescribe for PBA. The nuedexta.com patient website also links to virtual specialist appointments via Healthgrades.
No. Nuedexta is not a controlled substance and is not scheduled by the DEA. While dextromethorphan (one of its active ingredients) is sometimes misused at high doses, the FDA and DEA have not classified the fixed-dose combination product Nuedexta as a controlled substance.
Because Nuedexta is not controlled, prescriptions can be issued electronically, written for extended supplies, transmitted without special security paper, and filled at any licensed pharmacy. There are no special dispensing restrictions, prescription limits, or DEA registration requirements for prescribers beyond a standard DEA number. This makes Nuedexta easier to prescribe and fill than Schedule II–IV medications.
The most frequently reported common side effects of Nuedexta include:
Dizziness (most common; improves over time)
Diarrhea
Nausea and vomiting
Fatigue
Cough
Peripheral edema (swelling)
Urinary tract infection
Falls (increased risk due to dizziness)
Serious side effects requiring immediate medical attention:
Serotonin syndrome (muscle twitching, confusion, fever, sweating, agitation) — especially with MAOIs or SSRIs
QT prolongation / torsades de pointes (fainting, irregular heartbeat)
Immune-mediated thrombocytopenia (severe low platelets — lightheadedness, chills, fever, bleeding)
Hepatotoxicity / granulomatous hepatitis (jaundice, dark urine, abdominal pain)
Lupus-like syndrome (joint pain, rash, muscle aches, fever)
Know what you need? Skip the search.
Amitriptyline (Elavil)
TCA antidepressant used off-label for PBA. Evidence-based but carries anticholinergic side effects. Inexpensive generic ($10–$20/month). Not FDA-approved for PBA.
Nortriptyline (Pamelor)
TCA antidepressant used off-label for PBA; fewer side effects than amitriptyline. Preferred in elderly patients. Inexpensive generic. Not FDA-approved for PBA.
Citalopram (Celexa)
SSRI used off-label for PBA at 10–30 mg/day. Well-tolerated; favorable safety profile in elderly patients. Generic widely available. Not FDA-approved for PBA.
Sertraline (Zoloft)
SSRI used off-label for PBA at 50 mg/day; shown effective in small studies. Generic widely available at low cost. Not FDA-approved for PBA.
Prefer Nuedexta? We can find it.
MAOIs (phenelzine, tranylcypromine, selegiline)
majorContraindicated. Risk of life-threatening serotonin syndrome. Allow 14-day washout in both directions.
SSRIs (paroxetine, fluoxetine, sertraline)
majorCYP2D6 inhibition increases SSRI levels; serotonin syndrome risk. Limit paroxetine to max 35 mg/day. Monitor for serotonin syndrome.
Digoxin
majorQuinidine inhibits P-glycoprotein; can double digoxin plasma levels. Reduce digoxin dose and monitor levels closely.
Desipramine / TCAs
majorCYP2D6 inhibition can increase desipramine levels ~8-fold. Limit desipramine to max 40 mg/day if co-prescribed.
Thioridazine / Pimozide
majorContraindicated. Both prolong QT and are CYP2D6 substrates — dual risk of QT prolongation and drug accumulation.
Beta-blockers (metoprolol, carvedilol)
moderateCYP2D6 substrates. Quinidine inhibition can significantly increase plasma levels. Monitor for bradycardia and hypotension.
Alcohol / CNS depressants
moderateAdditive CNS depression. Avoid alcohol; use caution with benzodiazepines, sedatives, and antihistamines.
OTC dextromethorphan (cough medicines)
moderateAdditive dextromethorphan exposure; increased risk of serotonin syndrome. Check all OTC cough/cold products for DM content before use.
Nuedexta (dextromethorphan / quinidine) is the only FDA-approved treatment for pseudobulbar affect and represents a meaningful advance in quality of life for the hundreds of thousands of Americans living with this often-misunderstood neurological condition. It has been prescribed by more than 80,000 doctors and is backed by strong randomized controlled trial data across both ALS and MS patient populations.
The primary barriers to access are not clinical — Nuedexta is effective and well-tolerated for most patients — but logistical and financial: prior authorization requirements, specialty pharmacy routing, and high retail cost without a savings program. With the manufacturer's co-pay card, commercially insured patients can pay as little as $0 for a 90-day supply. For those without commercial insurance, the Otsuka Patient Assistance Foundation provides free medication for eligible patients.
If you're struggling to fill your Nuedexta prescription, medfinder can search pharmacies near you on your behalf — finding which ones have it in stock without the hours of phone calls. Finding your medication shouldn't be a full-time job.
Medfinder Editorial Standards
Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
ChatGPT
Claude
Perplexity
Grok
Gemini