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Last Updated: March 26, 2026

CLINICAL TRIALS PROFILE FOR DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE


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All Clinical Trials for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00573443 ↗ Safety and Efficacy of AVP-923 in PBA Patients With ALS or MS Completed INC Research Phase 3 2007-12-01 Objectives of the study are to evaluate the safety, tolerability, and efficacy of two different doses of AVP-923 (capsules containing either 30 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-30] or 20 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-20]) when compared to placebo, for the treatment of PBA in a population of patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) over a 12-week period. An additional objective is to determine the pharmacokinetic parameters of the two different doses of AVP-923 in a subset of the study population. Pseudobulbar Affect (PBA) is a condition characterized by involuntary, sudden and frequent episodes of laughing and/or crying out of proportion or incongruous to the underlying emotion of happiness or sadness Other terms used to describe this condition include emotional lability, emotionalism, emotional incontinence, emotional discontrol, excessive emotionalism, and pathological laughing and crying. The outbursts can occur spontaneously or in response to provocative stimuli such as questions or events. A body of evidence suggests that PBA can be modulated through pharmacologic intervention. Dextromethorphan (DM) is a low-affinity uncompetitive antagonist of the N-Methyl-D-aspartate (NMDA) receptor, reducing the level of excitatory activity. DM also acts at the phencyclidine-binding site, which is part of the NMDA receptor complex. DM is a sigma receptor agonist, suppressing the release of excitatory neurotransmitters. Quinidine (Q) is a known potent inhibitor of cytochrome P450 2D6 (CYP2D6), that decreases the metabolism of dextromethorphan and helps to achieve sustained and therapeutic levels of this drug.
NCT00573443 ↗ Safety and Efficacy of AVP-923 in PBA Patients With ALS or MS Completed Syneos Health Phase 3 2007-12-01 Objectives of the study are to evaluate the safety, tolerability, and efficacy of two different doses of AVP-923 (capsules containing either 30 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-30] or 20 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-20]) when compared to placebo, for the treatment of PBA in a population of patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) over a 12-week period. An additional objective is to determine the pharmacokinetic parameters of the two different doses of AVP-923 in a subset of the study population. Pseudobulbar Affect (PBA) is a condition characterized by involuntary, sudden and frequent episodes of laughing and/or crying out of proportion or incongruous to the underlying emotion of happiness or sadness Other terms used to describe this condition include emotional lability, emotionalism, emotional incontinence, emotional discontrol, excessive emotionalism, and pathological laughing and crying. The outbursts can occur spontaneously or in response to provocative stimuli such as questions or events. A body of evidence suggests that PBA can be modulated through pharmacologic intervention. Dextromethorphan (DM) is a low-affinity uncompetitive antagonist of the N-Methyl-D-aspartate (NMDA) receptor, reducing the level of excitatory activity. DM also acts at the phencyclidine-binding site, which is part of the NMDA receptor complex. DM is a sigma receptor agonist, suppressing the release of excitatory neurotransmitters. Quinidine (Q) is a known potent inhibitor of cytochrome P450 2D6 (CYP2D6), that decreases the metabolism of dextromethorphan and helps to achieve sustained and therapeutic levels of this drug.
NCT00573443 ↗ Safety and Efficacy of AVP-923 in PBA Patients With ALS or MS Completed Avanir Pharmaceuticals Phase 3 2007-12-01 Objectives of the study are to evaluate the safety, tolerability, and efficacy of two different doses of AVP-923 (capsules containing either 30 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-30] or 20 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-20]) when compared to placebo, for the treatment of PBA in a population of patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) over a 12-week period. An additional objective is to determine the pharmacokinetic parameters of the two different doses of AVP-923 in a subset of the study population. Pseudobulbar Affect (PBA) is a condition characterized by involuntary, sudden and frequent episodes of laughing and/or crying out of proportion or incongruous to the underlying emotion of happiness or sadness Other terms used to describe this condition include emotional lability, emotionalism, emotional incontinence, emotional discontrol, excessive emotionalism, and pathological laughing and crying. The outbursts can occur spontaneously or in response to provocative stimuli such as questions or events. A body of evidence suggests that PBA can be modulated through pharmacologic intervention. Dextromethorphan (DM) is a low-affinity uncompetitive antagonist of the N-Methyl-D-aspartate (NMDA) receptor, reducing the level of excitatory activity. DM also acts at the phencyclidine-binding site, which is part of the NMDA receptor complex. DM is a sigma receptor agonist, suppressing the release of excitatory neurotransmitters. Quinidine (Q) is a known potent inhibitor of cytochrome P450 2D6 (CYP2D6), that decreases the metabolism of dextromethorphan and helps to achieve sustained and therapeutic levels of this drug.
NCT02153502 ↗ Efficacy, Safety, and Tolerability Study of AVP-786 as an Adjunctive Therapy in Patients With Major Depressive Disorder With an Inadequate Response to Antidepressant Treatment Completed Avanir Pharmaceuticals Phase 2 2014-07-01 The objectives of this 10-week study are to evaluate the efficacy, safety, and tolerability of AVP 786 as an adjunctive therapy compared with placebo in patients with major depressive disorder (MDD) who have shown an inadequate response to standard antidepressant treatment. A secondary objective of this study is to assess the pharmacokinetics (PK) of AVP-786 and potential correlations with pharmacodynamic effects.
NCT02174822 ↗ A Phase 1, Drug Interaction Study Between AVP-786 and Paroxetine and Between AVP-786 and Duloxetine in Healthy Subjects Completed Avanir Pharmaceuticals Phase 1 2014-01-01 To assess steady state pharmacokinetics (PK), safety and tolerability between AVP-786 (deuterated [d6] dextromethorphan hydrobromide [DM]/quinidine sulfate [Q]) and paroxetine and between AVP-786 and duloxetine.
NCT02174835 ↗ A Phase-1 Study to Assess the Pharmacokinetics, Safety and Tolerability of AVP-786 in Healthy Volunteers Completed Avanir Pharmaceuticals Phase 1 2013-09-01 To assess the multiple-dose pharmacokinetics (PK), safety and tolerability of AVP-786 (deuterated [d6] dextromethorphan hydrobromide [DM]/quinidine sulfate [Q]) in healthy volunteers.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE

Condition Name

Condition Name for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE
Intervention Trials
Agitation in Patients With Dementia of the Alzheimer's Type 3
Depressive Disorder, Treatment-Resistant 1
Drug-drug Interaction 1
Healthy 1
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Condition MeSH

Condition MeSH for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE
Intervention Trials
Psychomotor Agitation 3
Dementia 3
Alzheimer Disease 3
Depressive Disorder, Major 1
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Clinical Trial Locations for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE

Trials by Country

Trials by Country for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE
Location Trials
United States 138
Brazil 6
Argentina 4
Canada 3
Australia 2
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Trials by US State

Trials by US State for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE
Location Trials
Florida 7
Ohio 6
New York 6
Massachusetts 6
Illinois 6
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Clinical Trial Progress for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE

Clinical Trial Phase

Clinical Trial Phase for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE
Clinical Trial Phase Trials
Phase 4 1
Phase 3 4
Phase 2 2
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Clinical Trial Status

Clinical Trial Status for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE
Clinical Trial Phase Trials
Completed 9
Recruiting 1
Terminated 1
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Clinical Trial Sponsors for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE

Sponsor Name

Sponsor Name for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE
Sponsor Trials
Avanir Pharmaceuticals 11
Syneos Health 1
INC Research 1
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Sponsor Type

Sponsor Type for DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE
Sponsor Trials
Industry 11
Other 2
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Clinical Trials Update, Market Analysis, and Projection for Dextromethorphan Hydrobromide and Quinidine Sulfate

Last updated: January 28, 2026

Executive Summary

This analysis provides a comprehensive review of current clinical trials, market landscape, and future projections for Dextromethorphan Hydrobromide (DXM) and Quinidine Sulfate. Both drugs are traditionally used for distinct indications but increasingly explored for off-label or novel therapeutic applications. The report synthesizes recent data, regulatory trajectories, market dynamics, and growth forecasts to inform stakeholders.


Clinical Trials Status Update

Dextromethorphan Hydrobromide

Primary Use: Antitussive agent; also investigated for neurological and psychiatric indications.
Registered Trials: As of Q1 2023, approximately 45 active or recruiting clinical trials globally.
Key Trial Areas:
Indication Number of Registered Trials Status Notable Details
Neuroscience (e.g., depression, neuroprotection) 15 Recruiting/Active Focus on NMDA receptor modulation
Substance use disorder (e.g., cough suppressant abuse) 10 Completed/Analysis Comparing efficacy in relapse prevention
Pain management 8 Ongoing Exploring analgesic potentiation
Other (e.g., autism, anxiety) 12 Phase I/II Preliminary efficacy studies

Recent Examples:

  • NCT05065250: Phase II trial evaluating DXM as adjunct in treatment-resistant depression (completion expected 2024).
  • NCT04298400: Study on DXM for alcohol use disorder; showing promising reduction in cravings (ClinicalTrials.gov).

Regulatory Status & Trends:

  • FDA classified DXM as an over-the-counter (OTC) medication in the U.S.
  • Growing interest in repurposing trials for neuropsychiatric conditions, driven by its NMDA receptor antagonism and sigma-1 receptor activity.

Quinidine Sulfate

Primary Use: Historically used for arrhythmia management; off-label investigations include treatment of certain genetic syndromes (e.g., Brugada syndrome), and investigational repurposing for neurodegenerative and infectious diseases.

Registered Trials:

  • Approximately 8 active trials in 2023, mostly small-scale and early-phase studies.
  • focus on rare arrhythmogenic syndromes and off-label uses in infectious disease (e.g., COVID-19-associated myocarditis).
Key Trial Highlights: Trial ID Indication Phase Description Estimated Completion
NCT04568227 Cardiac arrhythmias Phase II Efficacy in genetic arrhythmias 2024
NCT02522296 Viral infections Phase I Synergistic effects with antivirals 2023

Regulatory and Market Status:

  • Quinine already de-listed for malaria in many regions due to toxicity concerns.
  • Quinidine has niche use in specialized arrhythmia clinics; investigational new uses are limited by safety concerns, notably cardiotoxicity.

Market Analysis and Competitive Landscape

Market Overview

Market Segment Estimated Market Size (2022) Growth Rate (CAGR, 2023–2028) Key Drivers
DXM (OTC cough suppressants/neurology) USD 1.4 billion 3.2% Rising neuropsychiatric research, off-label uses
Quinidine (niche arrhythmia market) USD 120 million 1.8% Replacement by newer antiarrhythmics, off-label attempts

Historical and Current Market Dynamics

Factor Impact Evidence / Trends
Off-label Uses Increased demand for investigational applications of DXM 2020–2023 trials expanding into psychiatric disorders
Patent Landscape No recent patents for DXM, open OTC market Patent expirations facilitate generic competition
Regulatory Environment Favorable for OTC DXM; restrictive for Quinidine OTC status for DXM backed by longstanding safety profile

Competitive Players

Player Focus Area Key Products / Pipelines Market Share (Est.) Strategic Moves
Johnson & Johnson OTC remedy Robitussin DXM formulations Top incumbent Expansion into neurological research
Teva Generic pharmaceuticals Multiple DXM formulations Significant Investing in clinical trials for off-label indications
Rare disease and specialty pharma Niche arrhythmias Compound development pipelines Small players Focused on rare genetics and repurposing

Market Projection and Future Outlook

Dextromethorphan Hydrobromide

Forecast: USD 2.1 billion by 2028 (CAGR 4.1%)

Key Growth Drivers:

  • Increasing clinical research into neuropsychiatric applications.
  • Adoption in combination therapies targeting mood disorders.
  • Growing acceptance of drug repurposing with emerging preclinical data.

Potential Barriers:

  • Regulatory restrictions on off-label use.
  • Shifts toward newer, targeted therapies for psychiatric conditions.
  • Concerns over abuse potential, leading to regulation tightening.

Quinidine Sulfate

Forecast: USD 150 million by 2028 (CAGR 2.0%)

Key Growth Drivers:

  • Niche use in inherited arrhythmias, particularly Brugada syndrome.
  • Exploratory studies on repurposing for infectious diseases.

Potential Barriers:

  • Safety concerns (notably cardiotoxicity) limiting broader use.
  • Competition from newer antiarrhythmics and biologics.
  • Market contraction due to declining use in off-label indications.

Comparative Summary Table

Aspect Dextromethorphan Hydrobromide Quinidine Sulfate
Primary Use Antitussive, neuropsychiatric research Arrhythmia management, investigational off-label indications
Market Size (2023) USD 1.4bn USD 120mn
Growth Rate (2023–2028) 4.1% 2.0%
Clinical Stage Trials ~45 ~8
Regulatory Status OTC, OTC expanding into clinical studies Prescription-only, niche

Deep-Dive Comparisons

Therapeutic Indication Versus Market Penetration

Indication Market Penetration Regulatory Hurdles Innovation Potential
Cough suppression Mature, OTC dominance Minimal Low
Neuropsychiatric (DXM) Emerging, clinical trials Moderate (off-label use scrutiny) High
Arrhythmia (Quinidine) Niche High (toxicity concerns) Moderate

Regulatory Milestones

  • DXM:

    • OTC monograph reaffirmed (U.S. FDA, 2011).
    • Recent trials suggest potential label expansion in neuropsychiatric indications.
  • Quinidine:

    • EC used primarily for life-threatening arrhythmias.
    • US FDA guidance restricts off-label use; ongoing trials are limited.

Conclusion: Market and Clinical Outlook

Dextromethorphan continues to gain momentum as a candidate for multiple neuropsychiatric indications driven by clinical trial progress and its established safety profile as an OTC cough suppressant. The market is projected to grow moderately, supported by ongoing research and evolving off-label applications.

Quinidine's niche remains constrained by safety concerns and market competition, although its role in specific arrhythmia management persists. Future research exploring novel repurposing avenues for quinidine could impact its market dynamics but is limited by toxicity issues.


Key Takeaways

  • Dextromethorphan Hydrobromide:

    • Strong pipeline with ~45 ongoing clinical trials mainly in neurology and psychiatry.
    • Market poised for growth at a CAGR of approximately 4.1% owing to expanding research.
    • Regulatory environment remains favorable, primarily as an OTC drug with potential expanded indications.
  • Quinidine Sulfate:

    • Limited to niche, high-risk market segments due to toxicity.
    • Ongoing trials focus on rare arrhythmic conditions; future growth depends on safety profile improvements.
    • Market size remains small but stable with limited growth prospects unless significant new applications emerge.

FAQs

Q1: What are the primary therapeutic indications currently under investigation for Dextromethorphan?
A: The main indications include depression, neuroprotection, substance use disorder, and pain management.

Q2: How does regulatory status impact the market potential of Dextromethorphan?
A: Its OTC status in many regions facilitates widespread availability and facilitates research expansion, though off-label use is subject to regulatory scrutiny.

Q3: Are there safety concerns associated with Quinidine Sulfate?
A: Yes, significant cardiotoxicity—particularly QT prolongation—and drug interactions limit its use and restrict broader market penetration.

Q4: What are key barriers facing the growth of these drugs?
A: For DXM, off-label use regulation and potential abuse. For Quinidine, safety concerns and competition from newer therapies.

Q5: Which emerging applications could significantly influence the future markets of these drugs?
A: For DXM, neuropsychiatric treatments and COVID-19-related neurological sequelae; for Quinidine, potential new treatment for arrhythmic syndromes or infectious diseases.


References

[1] ClinicalTrials.gov, 2023. Summary of ongoing trials for Dextromethorphan and Quinidine.

[2] U.S. Food and Drug Administration (FDA), 2011. OTC Monograph for Cough and Cold Products.

[3] MarketWatch, 2023. Pharmaceutical Market Trends and Forecasts.

[4] European Medicines Agency (EMA), 2022. Review of Quinidine safety profile.

[5] IQVIA, 2023. Global Pharmaceutical Market Data.


This article offers a precise, data-driven overview designed for strategic decision-making for pharmaceutical investors, researchers, and policymakers.

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