Sequena, female patient with PBA in her 40s Sequena, female patient with PBA in her 40s

impact of pba

The impact of PBA
on patients is
substantial1

Pseudobulbar Affect (PBA) impacts patients’ lives, but they may not know how to talk about their symptoms.1,2 Prompt your patients to share their experiences

Sequena, patient living with PBA

Your patients may be suffering in silence

Uncontrollable crying and/or laughing episodes may result in immense distress, embarrassment, and confusion for the patient and their family.2,3

Because of the fear of having a PBA episode in public, patients may:

  • Restrict their social interactions1
  • Withdraw from loved ones1
  • Avoid leaving the house1
Carol, older female patient experiencing Pseudobulbar Affect (PBA) symptoms Carol, older female patient experiencing Pseudobulbar Affect (PBA) symptoms

What is it like to live
 
with PBA? Frankly,
 
it’s embarrassing.”

Carol, 
Patient living with PBA

PBA is often mistaken for depression. Hear how that impacts patients4

A white woman with long blonde hair is seen from the waist up, facing the camera. The caption on screen says “Jill, living with PBA.”

Why your patients may not be talking about their PBA symptoms

They may be embarrassed by their outbursts2

PBA can strike anytime, anywhere. Because episodes are uncontrollable, patients may not be able to stop crying and/or laughing in inappropriate settings.

They think their crying is a symptom of depression2,4

Since crying is common in depression, patients may attribute their PBA crying symptoms to their depression. They may not bring up these symptoms because they don't realize that PBA is a separate condition.

They may not realize that their symptoms are manageable2,5

If they don't know that treatment is available to reduce their episodes, they may not think to ask for help.

They may not understand what’s happening to them4,6,7

Laughing and crying are normal displays of emotion, but in patients with PBA, they can be exaggerated or incongruent with their underlying mood. So patients may not realize that what they're experiencing is part of a real neurologic condition.

Three circles with three steps: 1 - Ask 2 - Differentiate 3 - Document

The key to diagnosing PBA

Learn 3 steps to help you assess patients for PBA.

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Healthcare providers share why their patients didn't speak up sooner

Two healthcare providers share real patient stories and discuss why they believe their patients didn’t say something sooner about their uncontrollable crying and/or laughing.3

Drs Palladino and McVige are paid consultants of Otsuka America Pharmaceutical, Inc.

Screenshot image of video titled “Why Didn’t They Say Something?” and actor portrayals of a female experiencing Pseudobulbar Affect (PBA) crying symptoms around other people in a grocery story setting
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  • References: 1.

    Colamonico J, Formella A, Bradley W. Pseudobulbar affect: burden of illness in the USA. Adv Ther. 2012;29(9):775-798. doi:10.1007/‌s12325-012-0043-7

  • 2.

    Suavé WM. Recognizing and treating pseudobulbar affect. CNS Spectr. 2016;21(S1):34-44. doi:10.1017/‌S1092852916000791

  • 3.

    Miller A, Pratt H, Schiffer RB. Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments. Expert Rev Neurother. 2011;11(7):1077-1088. doi:10.1586/‌ern.11.68

  • 4.

    Brooks BR, Crumpacker D, Fellus J, Kantor D, Kaye RE. PRISM: a novel research tool to assess the prevalence of pseudobulbar affect symptoms across neurological conditions. PLoS One. 2013;8(8):e72232. doi:10.1371/‌journal.pone.0072232

  • 5.

    Work S, Colamonico J et al. Pseudobulbar affect: an under-recognized and under-treated neurological disorder. Adv Ther. 2011; 28(7):586-601. doi:10.1007/‌s12325-011-0031-3

  • 6.

    Hammond FM, Alexander DN, Cutler AJ, et al. PRISM II: an open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury. BMC Neurol. 2016;16:89. doi:10.1186/‌s12883-016-0609-0

  • 7.

    Nuedexta. Package insert. Otsuka America Pharmaceutical, Inc.; 2022.

IMPORTANT SAFETY INFORMATION and INDICATION for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate)

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS:

  • Quinidine and Related Drugs: NUEDEXTA contains quinidine and should not be used concomitantly with other drugs containing quinidine, quinine, or mefloquine.
  • Hypersensitivity: NUEDEXTA is contraindicated in patients with a history of NUEDEXTA-, quinine-, mefloquine-, or quinidine-induced thrombocytopenia, hepatitis, bone-marrow depression, lupus-like syndrome, or known hypersensitivity to dextromethorphan (e.g., rash, hives).
  • MAOIs: NUEDEXTA is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs), or in patients who have taken MAOIs within the preceding 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome. Allow at least 14 days after stopping NUEDEXTA before starting an MAOI.
  • Cardiovascular: NUEDEXTA is contraindicated in patients with a prolonged QT interval, congenital long QT syndrome, history suggestive of torsades de pointes, heart failure, patients receiving drugs that both prolong QT interval and are metabolized by CYP2D6 (e.g., thioridazine and pimozide), patients with complete atrioventricular (AV) block without implanted pacemaker, or at high risk of complete AV block.

Thrombocytopenia and Other Hypersensitivity Reactions: Quinidine can cause immune-mediated thrombocytopenia that can be severe or fatal. Non-specific symptoms, such as lightheadedness, chills, fever, nausea, and vomiting, can precede or occur with thrombocytopenia. NUEDEXTA should be discontinued immediately if thrombocytopenia occurs.

Hepatotoxicity: Hepatitis, including granulomatous hepatitis, has been reported in patients receiving quinidine, generally during the first few weeks of therapy. Discontinue immediately if this occurs.

Cardiac Effects: NUEDEXTA causes dose-dependent QTc prolongation. QT prolongation can cause torsades de pointes-type ventricular tachycardia, with the risk increasing as the degree of prolongation increases. When initiating NUEDEXTA in patients at risk for QT prolongation and torsades de pointes, electrocardiographic (ECG) evaluation of QT interval should be conducted at baseline and 3 to 4 hours after the first dose. Some risk factors include use with CYP3A4 inhibitors or drugs that prolong QT interval, electrolyte abnormalities, bradycardia, or left ventricular hypertrophy or dysfunction. If patients taking NUEDEXTA experience symptoms that could indicate the occurrence of cardiac arrhythmias (e.g., syncope or palpitations), NUEDEXTA should be discontinued, and the patient further evaluated.

Concomitant Use of CYP2D6 Substrates: NUEDEXTA inhibits CYP2D6 and may interact with other drugs metabolized by CYP2D6. Adjust dose of CYP2D6 substrates as needed.

Dizziness: NUEDEXTA may cause dizziness. Take precautions to reduce the risk of falls.

Serotonin Syndrome: Use of NUEDEXTA with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants increases the risk of “serotonin syndrome.”

Anticholinergic Effects of Quinidine: Monitor for worsening in myasthenia gravis.

Adverse Reactions: The most common adverse reactions (incidence of ≥3% and two-fold greater than placebo) in patients taking NUEDEXTA are diarrhea, dizziness, cough, vomiting, asthenia, peripheral edema, urinary tract infection, influenza, increased gamma-glutamyltransferase, and flatulence.

These are not all the risks for use of NUEDEXTA.

To report SUSPECTED ADVERSE REACTIONS, contact Otsuka America Pharmaceutical, Inc. at 1-800-438-9927 or FDA at 1-800-FDA-1088 (www.fda.gov/‌medwatch).

INDICATION

NUEDEXTA is indicated for the treatment of pseudobulbar affect (PBA).

PBA occurs secondary to a variety of otherwise unrelated neurologic conditions, and is characterized by involuntary, sudden, and frequent episodes of laughing and/or crying. PBA episodes typically occur out of proportion or incongruent to the underlying emotional state. PBA is a specific condition, distinct from other types of emotional lability that may occur in patients with neurologic disease or injury.

Please see FULL PRESCRIBING INFORMATION.