Wahler Robert G, Reiman Alfred T, Schrader Joshua V
1 Niagara Hospice , Lockport, New York.
2 University at Buffalo, The State University of New York, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York.
J Palliat Med. 2017 Mar;20(3):294-297. doi: 10.1089/jpm.2016.0277. Epub 2016 Dec 20.
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.
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.
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.
Episodes of PBA symptoms were summarized in a narrative of the patients' symptom relief.
Both patients tolerated the administration of the DMQ suspension and there were noted improvements in PBA symptoms.
DMQ suspension is an effective alternative for PBA symptoms in patients who cannot swallow oral solid medication.
假性延髓情绪（PBA）表现为无端且无法控制的哭笑发作。在临终情况下，PBA症状在本就情绪高度紧张的时期，可能会让家人和朋友格外痛苦。尽管一种右美沙芬和奎尼丁的复方制剂（DMQ）已获美国食品药品监督管理局（FDA）批准用于治疗PBA，但许多临终关怀患者无法吞咽任何固体或半固体食物。因此需要为这些患者提供一种替代剂型。
我们在此介绍两例病例，在这两例中，我们成功使用了一种自制的DMQ混悬液，在患者死亡前数周治疗PBA症状。
对使用DMQ混悬液的两例病例进行了回顾性病历审查，并描述了DMQ混悬液配方。
地点/受试者：两名患者均在临终关怀项目的照料下；一名接受居家护理，一名在专业护理机构。
通过患者症状缓解情况的叙述总结PBA症状发作情况。
两名患者均耐受DMQ混悬液给药，且PBA症状有改善。
对于无法吞咽口服固体药物的患者，DMQ混悬液是治疗PBA症状的一种有效替代方法。
