The DMQ program

What does the DMQ program

The DMQ (dextromethorphan/quinidine) program is an offer in the APST care network and a component of our ALS pharmacy program.

Difficulties with speech (dysarthria) and swallowing (dysphagia) are common complaints in ALS, which are often perceived as very stressful. Medications such as dextromethorphan/quinidine (DMQ) and pyridostigmine

can be used to improve the symptoms or at least keep them stable.

The decision whether or not to take DMQ depends on the severity of the speech disorder and is an individual decision.

Further information

What is the DMQ program?

The DMQ program has been developed in specialist pharmacies in the APST network (ALS pharmacies) to support the decision for treatment with DMQ. The final decision on DMQ medication is made by a specialist in neurology. The patient is of course involved in this process. In ALS outpatient clinics, the ALS Functional Rating Scale (ALSFRS-R) is an important guide in the decision-making process. Speech function is determined by the ALS Functional Scale (question 1 of the ALSFRS-R). The ALSFRS-R occupies a special position, as this scale can be used by both the doctor and the patient (ALSFRS-R-SE).

The ALSFRS-R-SE self-assessment via the ALS app allows patients to communicate their ALS-related symptoms (including speech) in a structured way. The results of the ALSFRS-R-SE self-assessment can be viewed by trained coordinators in the APST care network and by ALS pharmacies. If a speech disorder is present, both pharmacies and coordinators can make a basic recommendation for DMQ treatment. The final decision lies with the doctor. The collaboration between ALS pharmacists, ALS coordinators, the affected person and the doctor is known as the DMQ program.

The DMQ program has the following contents

– Recording of question 1 of the ALSFRS functional scale (speaking) by ALS pharmacy.
– Recommendation of DMQ treatment by ALS pharmacy to doctor (for 3 to 2 scale points in question 1 of the ALSFRS-R-SE).
– Sending a doctor’s note with information on the medical prescription from the ALS pharmacy to the patient (for forwarding to the doctor’s practice).
– Monthly self-assessment for speaking via ALS app (only if participating in ALS app).
– Consultation between the ALS pharmacy and the patient or relatives regarding the speech disorder and recommendation of symptomatic medication by the ALS pharmacy to the doctor.

Further links

Spittel S, Grehl T, Weydt P, Kettemann D, Fabian R, Rödiger A, Smesny U, Steinbach R, Ilse B, Weyen U, Petri S, Lumi R, Bjelica B, Lingor P, Grosskreutz J, Göricke BM, Pfeilschifter W, Schmeja W, Dorst J, Mensch A, Siebert J, Norden J, Bernsen S, Subramanian SK, Hildebrandt B, Walter B, Münch C, Maier A, Meyer T. Dextromethorphan/quinidine (DMQ) for reducing bulbar symptoms in amyotrophic lateral sclerosis – assessment of treatment experience in a multicenter study. Amyotroph Lateral Scler Frontotemporal Degener. 2025 Sep 11:1-13. [Link to the publication]

Spittel S, Kettemann D, Grehl T, Weydt P, Fabian R, Bernsen S, Weyen U, Rödiger A, Steinbach R, Petri S, Lumi R, Bjelica B, Lingor P, Göricke BM, Posa A, Ludolph AC, Dorst J, Norden J, Körtvélyessy P, Hildebrandt B, Walter B, Münch C, Maier A, Meyer T. Dextromethorphan/quinidine (DMC) in the treatment of bulbar symptoms in ALS – patient-reported outcomes of a multicenter study. Neurology 2025; 44(03): 139 – 139. [Link to the abstract]

Tabor Gray L, Locatelli E, Vasilopoulos T, Wymer J, Plowman EK. Dextromethorphan/quinidine for the treatment of bulbar impairment in amyotrophic lateral sclerosis. Ann Clin Transl Neurol. 2023 Aug;10(8):1296-1304. doi: 10.1002/acn3.51821.

Maier A, Boentert M, Reilich P, Witzel S, Petri S, Großkreutz J, Metelmann M, Lingor P, Cordts I, Dorst J, Zeller D, Günther R, Hagenacker T, Grehl T, Spittel S, Schuster J, Ludolph A, Meyer T; MND-NET consensus group. ALSFRS-R-SE: an adapted, annotated, and self-explanatory version of the revised amyotrophic lateral sclerosis functional rating scale. Neurol Res Pract. 2022 Dec 15;4(1):60. doi: 10.1186/s42466-022-00224-6.

Management of the program

Do you have questions about the DMQ program? I will be happy to help you!

Dr. Dr. Susanne Spittel

Head of Research and Pharmacy Programs

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