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To the Editor:
The study by Brooks et al.1 demonstrating positive effects of dextromethorphan/quinidine (DM/Q) in the treatment of pseudobulbar affect in ALS is groundbreaking. The study convincingly demonstrates efficacy in treatment of this difficult and debilitating condition. In addition, the formulation studied is unique because it combines, in a single dose form, both the active drug and an inhibitor of the CYP450 pathway responsible for metabolism of the active drug. Although manipulation of CYP450 pathways by coadministration of a second drug has been used in a number of clinical settings in the past (e.g. the use of so-called “sparing agents” with cyclosporin and tacrolimus),2,3 AVP-923 is the first to combine the two in the same formulation.
In the accompanying Commentary,4 Katz expresses …
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