Has anyone every prescribed or used dextromethorphan transdermally in cream form for the innappropriate giggling or crying that comes with pseudo bulbar affect? Apparently Dextromethorphan is coupled with quinidine in the new pseudo bulbar drug Nuedexta. But quinidine is not without potential side effects and contraindications and its only reason in the formulation is to increase the level of the DM so that it has less first-pass effect in the liver.

so my question is if anyone has ever used DM alone transdermally for this use?? Transdermally, it would undergo less metabolism to its inactive/unable to pass blood brain barrier metabolite. it just makes sense to try. Anyone have any thoughts on this?

I didn't even know this came in a cream form. DM has disassociative effects, I have used this for pain, but now I am taking namenda instead. I can see why it wold stop pseudo bulba affect, (though I don't have that) because it is hard to even care about what other people are saying when I take this med, the Namenda does not have this effect.

My thought was suppositories to get around the problem but I haven`t tried as its not for myself. I also was thinking of Benadryl or Cannabidiol to do the job like quinidine. His doctor said we could try nuedexta but his insurance won`t offer it and the paper work sent in for patient assistance fell on deaf ears. It would be for an anoxic brain injury here that I seen first hand a great improvement when given low dose DM . Post if you come up with something so I can add it to my notes. Thanks, Ruth

Namenda 28 mg at night
Memantine 10 mg 1-3 times per day

Amazing!