Use of Compounded Dextromethorphan-Quinidine Suspension for Pseudobulbar Affect in Hospice Patients

Background: Pseudobulbar affect (PBA) consists of unprovoked and uncontrollable episodes of laughing and/or crying. In end-of-life situations, PBA symptoms can be especially distressing to family and friends during an already heightened emotional time. Although a commercial product combining dextromethorphan and quinidine (DMQ) is FDA approved for use in PBA, many hospice patients are unable to swallow any solids or semisolids. An alternative formulation for these patients is needed. Objective: We present here two cases in which we used a compounded DMQ suspension successfully to treat PBA symptoms in the weeks before the patients' death. Design: A retrospective chart review was completed on the two cases where the DMQ suspension was used. A description of the DMQ suspension formula is described. Setting/Subjects: Both patients were under the care of a hospice program; one in home care and one in a skilled nursing facility. Measurements: Episodes of PBA symptoms were summarized in a narrative of the patients' symptom relief. Results: Both patients tolerated the administration of the DMQ suspension and there were noted improvements in PBA symptoms. Conclusions: DMQ suspension is an effective alternative for PBA symptoms in patients who cannot swallow oral solid medication.