II. Mechanism
- Amantadine derivative with Dopaminergic effects
III. Dosing
- Background
- Memantine has a long enough half life to be dosed once daily
- Memantine regular once daily has equivalent efficacy to Mamantine XR
- Memantine regular is generic in 2015 (with brand name discontinued in 2014)
- Memantine (Namenda, Ebixa in Europe)
- Start: 5 mg orally daily for at least 1 week
- Next: 5 mg orally twice daily for at least 1 week
- Next: 10 mg orally each AM and 5 mg orally each night for at least 1 week
- Next: 10 mg orally twice daily
- Memantine ER (Namenda XR)
- Start 7 mg orally daily
- Titrate daily dose by 7 mg on a weekly basis to maximum of 28 mg daily
- Maximum 28 mg/day (14 mg/day in renal Impairment)
IV. Indications: Moderate to severe Dementia
- Consider as alternative to Cholinesterase Inhibitor (e.g. Aricept) if side effects limit use
- Memantine may be better tolerated than Cholinesterase Inhibitors
- Previously added on to Cholinesterase Inhibitor protocol for added benefit
- Combination therapy no longer recommended due to low efficacy (only helped 1 in 12)
- Combination therapy is associated with gastrointestinal side effects, Bradycardia and Syncope
V. Efficacy
- Can improve cognition and function
VI. Pharmacokinetics
- Half-life (Memantine): 60-80 hours
VII. Adverse Effects
- Common adverse effects
- Rare but serious adverse effects
VIII. References
- (2014) Presc Lett 21(5): 26
- (2013) Presc Lett 20(7): 41
- (2012) Presc Lett 19(5): 28
- Epperly (2017) Am Fam Physician 95(12): 771-8 [PubMed]
- Tariot (2004) JAMA 291:317-24 [PubMed]
- Howard (2012) N Engl J Med 366:893-903 [PubMed]
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| memantine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MEMANTINE 5-10 MG TITRATION PK | Generic | $0.41 each |
| MEMANTINE HCL 10 MG TABLET | Generic | $0.20 each |
| MEMANTINE HCL 5 MG TABLET | Generic | $0.19 each |
| namenda (on 1/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| NAMENDA 10 MG TABLET | Generic | $0.20 each |
| NAMENDA 2 MG/ML SOLUTION | $2.11 per ml | |
| NAMENDA 5 MG TABLET | Generic | $0.19 each |
| NAMENDA 5-10 MG TITRATION PK | Generic | $0.41 each |
| NAMENDA XR 14 MG CAPSULE | $12.43 each | |
| NAMENDA XR 21 MG CAPSULE | $12.43 each | |
| NAMENDA XR 28 MG CAPSULE | $12.42 each | |
| NAMENDA XR 7 MG CAPSULE | $12.39 each | |
| NAMENDA XR TITRATION PACK | $12.33 each | |
Ontology: Memantine (C0025242)
| Definition (MSH) | AMANTADINE derivative that has some dopaminergic effects. It has been proposed as an antiparkinson agent. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D008559 |
| SnomedCT | 406457005, 406458000 |
| LNC | LP100043-1, MTHU035864 |
| English | 1,3-Dimethyl-5-aminoadamantane, 1-Amino-3,5-dimethyladamantane, Memantin, Memantine, Tricyclo(3.3.1.13,7)decan-1-amine, 3,5-dimethyl-, DIMETHYLAMINOADAMANTANE 01 03 05, Memantine [Chemical/Ingredient], memantin, memantine, MEMANTINE, Memantine (product), Memantine (substance) |
| Swedish | Memantin |
| Czech | memantin |
| Finnish | Memantiini |
| Russian | MEMANTIN, 1,3-DIMETIL-5-AMINOADAMANTAN, D 145, 1,3-ДИМЕТИЛ-5-АМИНОАДАМАНТАН, МЕМАНТИН |
| German | DIMETHYLAMINOADAMANTAN 01 03 05, 1,3-Dimethyl-5-Aminoadamantan, Memantin |
| Polish | Memantyna |
| Japanese | メマンチン塩酸塩, 1,3-ジメチル-5-アミノアダマンタン, メマンチン, 塩酸メマンチン |
| Spanish | memantina (producto), memantina (sustancia), memantina, 1,3-Dimetil-5-aminoadamantano, Memantina |
| French | Mémantine |
| Italian | Memantina |
| Portuguese | 1,3-Dimetil-5-aminoadamantano, Memantina |
Ontology: NMDA receptor antagonist (C0598695)
| Concepts | Pharmacologic Substance (T121) |
| SnomedCT | 414858002, 406456001 |
| English | NMDA receptor antagonist (substance), N-methyl-D-asparate (NMDA) receptor antagonist, N-methyl-D-aspartate (NMDA) receptor antagonist, N-methyl-D-asparate (NMDA) receptor antagonist (substance), NMDA receptor antagonist, n-methyl-D-aspartate receptor antagonist, N-methyl-D-aspartate (NMDA) receptor antagonist (substance), NMDA receptor antagonist (product), N-methyl-D-aspartate receptor antagonist (substance), n-methyl-D-aspartate receptor antagonist (product), N-methyl-D-aspartate receptor antagonist |
| Spanish | antagonista del receptor de N-metil-D-aspartato (producto), antagonista del receptor de N-metil-D-aspartato, antagonista del receptor de NMDA, antagonista del receptor de N-metil-D-aspartato (sustancia) |
Ontology: Namenda (C1330412)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D008559 |
| English | Namenda XR, Namenda |
