Nursing Homes: Antipsychotic Drugs Out, Nuedexta In?
In the 1999 science-fiction film The Matrix, the main character, Neo, is given a choice. Will he take the blue pill, allowing him to return to his normal life, or the red pill, which will reveal to him the truth about the world that he’s living in?
If only there were pills that worked like that in real life. For dementia patients, something like the blue pill would be wonderful.
But the pill now making the rounds at American nursing homes is a “little red one.” It’s called Nuedexta, and it’s meant to suppress symptoms of pseudobulbar affect, or PBA. PBA is a neurological disorder that sometimes occurs in people who have suffered brain or nerve damage: traumatic brain injury, multiple sclerosis, Lou Gehrig’s disease, and dementia, among other things. Sufferers have fits of uncontrollable laughing or crying that don’t agree with their actual emotions at the moment.
Nursing homes in the U.S., in response to the Centers for Medicare & Medicaid Services’ directive to decrease the amount of antipsychotic drugs given to nursing home residents, have upped patients’ doses of Nuedexta instead.
For dementia patients, Nuedexta may be unnecessary, and dangerous.
Nuedexta, manufactured by Avanir Pharmaceuticals, Inc., is composed of the drugs dextromethorphan and quinidine. Dextromethorphan, which affects signals in the brain, is mainly used as a cough suppressant, and quinidine produces changes in heart rhythm. (People with a history of heart problems should not be given Neudexta.)
Avanir has targeted Alzheimer’s patients with aggressive marketing. It claims that PBA is an under-diagnosed but common condition in people with dementia (though experts say only 1% of the U.S. population has PBA), and makes money by “expanding the drug’s use among elderly patients…and high-volume prescribing and advocacy efforts by doctors receiving payments from the company,” as a CNN investigation found. Last year, sales reached $300 million for the company.
However, “when Nuedexta hit the market in 2011, doctors, nurses and family members of patients began reporting symptoms such as rashes, dizziness, falls, coma, and even death.”
The Side Effects of Nuedexta
According to Avanir itself, Nuedexta’s side effects include, but are not limited to: diarrhea, dizziness, cough, vomiting, weakness, and swelling of feet and ankles. We already know that it increases the risk of falls—twice as much, CNN found—and falls are much more serious for nursing home residents than PBA can be. Neudexta’s effects have not yet been thoroughly studied in the elderly, and it can react badly with other medications.
MAOIs are drugs sometimes used to treat mental illnesses, such as depression. Neudexta, when mixed with any of these drugs, can create a potentially lethal reaction—serotonin syndrome. In addition, the quinidine in Neudexta can alter the patient’s heart rate dramatically if he or she is already taking a quinidine, or a similar-based medication. Over-the-counter cough medicines are also now dangerous; and believe it or not, grapefruit juice also has an effect on Nuedexta.
Despite all these risks, long-term care facilities buy half of all Neudexta pills being sold.
Why Are Nursing Homes Relying on Neudexta?
Having dementia does not automatically mean that a person has PBA, and Neudexta should only be prescribed for specific people who suffer from PBA. Nursing homes and other assisted living facilities tend to overmedicate “difficult” patients like dementia patients in an attempt to keep them quiet and make up for understaffing. If Neudexta has been found to “suppress” difficult behavior in Alzheimer’s patients, it’s no wonder that caregivers at these facilities have been using it!
Whether through carelessness or laziness, the over-prescription of Neudexta can have devastating consequences on the residents’ quality of life. There are alternative treatments available, and drugging someone is the wrong solution to this problem—especially when the drug is meant to treat something else!
If your family member was harmed in a nursing home and you believe Neudexta had something to do with it, find out all you can. It’s not okay for these facilities to give unnecessary medication to people, or administer dangerous drugs that can cause a bad reaction. Speak to Travis Siegel, dedicated elder attorney at Siegel Law, if you have any question about medication errors. Dial 562-645-4145 for a free consultation.