Cough Suppressant – The New Choice in Chemical Restraint?

For years, pharmaceutical company Avanir has been steadily drumming up support for use of its drug Nuedexta as a “treatment” for dementia related “symptoms.” The September edition of an American Medical Director’s Association newsletter recently featured a story touting the drug’s ability to control agitation and aggression in patients with dementia. There are many reasons to seriously doubt the efficacy of drugs like Nuedexta in dementia care treatments and even more reasons to spurn its use.

For starters, Nuedexta is not FDA-approved for use in dementia. Also, adding any new drug to those which a demented individual already receives may in itself actually cause confusion and agitation. Perhaps even more importantly, the Nuedexta study reported by AMDA was paid for by Avanir. If that wasn’t enough, the physician who apparently was part of the study and has been publicizing its results is a paid speaker for Avanir.

Since last week, the Huffington Post has been releasing a new chapter each day in its compelling and disturbing “docu-serial” on the mismarketing of Risperdal for children and dementia patients.  It seems as though Avanir is borrowing from the Risperdal playbook. Take a drug with a sedating effect and promote its use for older people with dementia to “treat” their “symptoms” by quieting and calming them.

And then there’s Nuedexta’s chemical makeup. It’s dextromethorphan, or DXM, an active ingredient in cough syrup that causes, among other things, drowsiness and fatigue. The DXM is mixed with quinidine, which slows down the metabolizing of DXM so it packs a more sustained punch. This mix is certainly not being sold as something that improves the thought processing of people with dementia; rather, it’s the ability to restrain and stop their activity that gives the drug its alleged value.

People with dementia have been getting drugs to sedate them for generations. The names of the drugs come and go but the outcomes remain the same: sleepy, lethargic patients who fall and lose weight and stop walking and suffer. But they are quiet. And that’s why there are billions of dollars at stake.

The greatest scandal in the insistent demand and supply of sedating drugs for dementia patients is that it feeds off the myth that agitation or aggression are symptoms of dementia and not simply the best way that someone with dementia has of telling us something is wrong, that they are uncomfortable or frightened. Until care providers understand that behavior is communication and not a medical symptom, there will continue to be a massive market for snake oil sedatives sold as “treatment.” Ladies and gentlemen, I give you Nuedexta.

 

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About achicotel

Anthony Chicotel is a staff attorney for CANHR. His areas of expertise include the rights of long-term care residents, nursing home litigation, health care decision-making, and conservatorships.
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