Generic Nuedexta, sold as dextromethorphan and quinidine, is available in the US in the same 20 mg / 10 mg capsule strength as the brand. This guide covers what it costs, what it treats, how it is taken and what side effects to watch for.
This information is educational and does not replace advice from your own healthcare provider. Never start, stop or change a medicine without talking to your prescriber.
Is There a Generic for Nuedexta?
Yes, a generic version of Nuedexta is available in the US under the name dextromethorphan and quinidine, according to Lexidrug.
Both the brand and the generic come as oral capsules containing dextromethorphan hydrobromide 20 mg and quinidine sulfate 10 mg. Whether your plan covers the brand, the generic or both depends on your insurance.
Generic availability, manufacturers and plan coverage can change. Your pharmacist can confirm which versions are available to you.
How Much Does Nuedexta Cost?
Brand-name Nuedexta has an average wholesale price of about $2,003 for a 30-day supply at the standard dose, and generic dextromethorphan and quinidine lists at about $1,803 to $1,903.
| Medication | Strength | 30-Day Supply | AWP per Capsule | Approx. 30-Day AWP |
|---|---|---|---|---|
| Generic dextromethorphan and quinidine | 20 mg / 10 mg | 60 capsules | $30.05 to $31.72 | $1,803 to $1,903 |
| Brand-name Nuedexta | 20 mg / 10 mg | 60 capsules | $33.39 | $2,003 |
The 30-day figures multiply the per-capsule AWP by 60 capsules, the amount used at the standard maintenance dose of one capsule every 12 hours. What you actually pay depends on your insurance, deductible, pharmacy and any assistance you qualify for.
Pricing reflects Average Wholesale Price (AWP) from Lexidrug (Medi-Span), reviewed September 25, 2026. AWP is a benchmark list price. It is not a quote, an offer or a guarantee of what any patient will pay. Actual cost varies by pharmacy, dose, insurance and available assistance, and prices change over time.
How Can I Lower the Cost of Nuedexta?
Depending on your insurance, you may be able to lower your Nuedexta cost through a manufacturer card, patient assistance or an independent foundation grant.
QuickRx Specialty Pharmacy applies for these on your behalf at no cost to you, and eligible patients may pay $0. Learn more on our Nuedexta assistance page or call (917) 830-2525.
Assistance availability, eligibility and savings depend on each program’s own rules and your insurance, and approval is not guaranteed. QuickRx applies on your behalf and does not issue copay cards or grants.
What Is Nuedexta Used For?
Nuedexta is FDA-approved to treat pseudobulbar affect (PBA), a neurologic condition that causes sudden, uncontrollable episodes of crying or laughing that do not match how a person feels.
PBA usually happens alongside another neurologic condition, such as ALS, multiple sclerosis, stroke or a traumatic brain injury. Read our full guide to pseudobulbar affect symptoms, causes and treatment.
Lexidrug also lists dextromethorphan and quinidine as an off-label option for agitation in Alzheimer disease, based on a 10-week phase 2 trial. Off-label means the FDA has not approved it for that use, and the evidence is rated limited (Level C).
How Does Nuedexta Work?
Nuedexta pairs dextromethorphan, which acts on the brain to reduce PBA episodes, with a low dose of quinidine, which slows the body’s breakdown of dextromethorphan.
Dextromethorphan binds to sigma-1 receptors in the brain, although its exact mechanism in PBA is not known. Quinidine blocks the liver enzyme CYP2D6, and taking the two together raises the bioavailability of dextromethorphan about 20-fold. The quinidine dose in Nuedexta is 1% to 3% of the amount used to treat heart rhythm disorders, according to Lexidrug.
Nuedexta Dosage
The labeled Nuedexta dose for PBA is one capsule (dextromethorphan 20 mg / quinidine 10 mg) once daily for 7 days, then one capsule every 12 hours.
- May be taken with or without food
- Space the two daily doses about 12 hours apart
- Do not exceed two capsules (dextromethorphan 40 mg / quinidine 20 mg) in 24 hours
- Your prescriber should reassess periodically whether you still need it, since PBA can improve on its own
No dose change is listed for mild to moderate kidney or liver impairment; severe impairment has not been studied, according to Lexidrug.
This information is educational and does not replace advice from your own healthcare provider. Never start, stop or change a medicine without talking to your prescriber.
Nuedexta Side Effects
The most common side effect of Nuedexta is diarrhea, reported in 13% of adults, according to Lexidrug.
| Side effect | Reported in |
|---|---|
| Diarrhea | 13% |
| Dizziness | 10% |
| Swelling of the legs or feet (peripheral edema) | 5% |
| Vomiting | 5% |
| Weakness (asthenia) | 5% |
| Cough | 5% |
| Urinary tract infection | 4% |
| Influenza | 4% |
| Gas (flatulence) | 3% |
| Increased liver enzyme GGT | 3% |
Falls, abdominal pain, muscle spasms and QT prolongation on an ECG have also been reported without a defined frequency. This is not a complete list. Tell your prescriber about any side effect that bothers you or does not go away.
Serious Warnings and Who Should Not Take Nuedexta
Nuedexta can cause serious heart rhythm changes, low platelet counts, liver problems and dangerous drug interactions, so it is not safe for everyone.
Do not take Nuedexta if you:
- Are allergic to dextromethorphan, quinidine, quinine or mefloquine
- Take other medicines containing quinidine, quinine or mefloquine
- Have taken an MAO inhibitor in the last 2 weeks
- Have a prolonged QT interval, congenital long QT syndrome or a history of torsade de pointes
- Have heart failure
- Have complete heart block without a pacemaker, or are at high risk of it
- Have had low platelets, hepatitis, bone marrow problems or a lupus-like reaction from quinine, quinidine or mefloquine
Get medical help right away for a fast or abnormal heartbeat or fainting; unusual bleeding or bruising; dark urine or yellow skin or eyes; signs of serotonin syndrome such as agitation, confusion, fever, muscle twitching or stiffness; or signs of an allergic reaction.
Before starting, people at risk for QT prolongation should have an ECG at baseline and 3 to 4 hours after the first dose, and potassium and magnesium should be checked, according to Lexidrug.
Nuedexta Drug and Food Interactions
Nuedexta interacts with many medicines, so your prescriber and pharmacist should review everything you take before you start.
- MAO inhibitors: must not be combined, or taken within 2 weeks of each other
- QT-prolonging drugs metabolized by CYP2D6 (for example, pimozide and thioridazine): must not be combined
- SSRIs, SNRIs, triptans and other serotonergic drugs: can raise the risk of serotonin syndrome
- Medicines broken down by CYP2D6 (including some antidepressants, some antipsychotics and tamoxifen): quinidine can raise their levels or reduce their effect
- Moderate or strong CYP3A4 inhibitors: may raise quinidine levels and further prolong the QT interval
- Grapefruit juice and tonic water: avoid; grapefruit can raise quinidine levels and tonic water contains quinine
This is not a complete list of interactions.
This information is educational and does not replace advice from your own healthcare provider. Never start, stop or change a medicine without talking to your prescriber.
Frequently Asked Questions About Generic Nuedexta
Is generic Nuedexta the same as brand-name Nuedexta?
Generic dextromethorphan and quinidine contains the same two active ingredients in the same 20 mg / 10 mg capsule strength as brand-name Nuedexta, according to Lexidrug.
Inactive ingredients can differ between manufacturers. Ask your pharmacist whether a generic substitution is appropriate for your prescription and your plan.
Can I drink alcohol while taking Nuedexta?
Alcohol may increase the side effects of dextromethorphan, one of the two ingredients in Nuedexta, according to Lexidrug.
Ask your prescriber or pharmacist whether any alcohol is safe for you.
Is Nuedexta safe during pregnancy or breastfeeding?
Adverse events were seen in animal reproduction studies with this combination, and quinidine is known to pass into breast milk, according to Lexidrug.
Whether dextromethorphan passes into breast milk is not known. If you are pregnant, planning a pregnancy or breastfeeding, talk with your prescriber about the risks and benefits before taking it.
Is Nuedexta safe for older adults?
The 2023 Beers Criteria list dextromethorphan and quinidine as a medicine to use with caution in adults 65 and older because of risks of falls, drug interactions and QTc prolongation, while noting it is still appropriate for treating PBA.
Lexidrug also notes that data in older adults show an increased risk of falls, even with short-term use.
How should Nuedexta be stored?
Store Nuedexta at 25°C (77°F), with brief excursions allowed between 15°C and 30°C (59°F to 86°F), according to Lexidrug.
Keep it out of reach of children and pets.
Can children take Nuedexta?
The safety and effectiveness of Nuedexta have not been established in patients under 18, according to its FDA prescribing information.
References
- Lexidrug (UpToDate Lexidrug, Wolters Kluwer Health). Dextromethorphan and Quinidine monograph. Last Updated 9/25/26. Includes Pricing: US data from Medi-Span.
- Nuedexta (dextromethorphan hydrobromide and quinidine sulfate) prescribing information. DailyMed, U.S. National Library of Medicine.
- MedlinePlus: Dextromethorphan and Quinidine. U.S. National Library of Medicine.
- 2023 American Geriatrics Society Beers Criteria Update Expert Panel. J Am Geriatr Soc. 2023;71(7):2052-2081. PubMed.
- Cummings JL, et al. Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia. JAMA. 2015;314(12):1242-1254. PubMed.
Medical Disclaimer: This article is for educational purposes only and does not replace professional medical advice, diagnosis or treatment. Always talk with your neurologist, primary care provider or pharmacist about your own condition and treatment. Drug information is current as of September 25, 2026 and may change. Statistics describe groups of people studied and cannot predict any one person’s experience.
