Memantine

Indications
Oral
Moderate to severe dementia in Alzheimer's disease
Adult: As hydrochloride: Initially, 5 mg daily in the morning for the 1st wk; increase dose wkly in steps of 5 mg. Max: 20 mg daily. Wait for at least 1 wk between dose changes. Doses ≥10 mg/day should be given in 2 divided doses. Suggested titration: 5 mg daily for ≥1 wk; 5 mg bid for ≥1 wk; 15 mg daily given in 5- and 10-mg separated doses for ≥1 wk; then 10 mg bid.
CrCl (ml/min)Dosage Recommendation
40-60Per 1.73 m2: Max dose: Reduce to 10 mg daily.


Special Populations: In moderate renal impairment, dose reduction is recommended, and avoid use if severe renal impairment.
Contraindications
Severe renal impairment.
Warnings / Precautions
Renal impairment; epilepsy. Pregnancy and lactation. Closely monitor patients with recent MI, uncompensated CHF, uncontrolled hypertension. Predisposition to convulsions; conditions that increase urinary pH.
Adverse Reactions
Dizziness, confusion, headache, constipation, somnolence, hallucinations, tiredness, vomiting, anxiety, abnormal gait, hypertonia, cystitis and increased libido. Rarely, psychotic reactions, pancreatitis.
Overdose Reactions
Symptoms: Loss of consciousness, psychosis, restlessness, somnolence, stupor, visual hallucinations. Management: Symptomatic and supportive. Elimination may be increased by acidifying the urine.
Drug Interactions
May increase effects of antimuscarinics and dopaminergics. May reduce effects of antipsychotics and barbiturates. May alter effects of dantrolene, baclofen. Reduced clearance with carbonic anhydrase inhibitors and sodium bicarbonate.
Potentially Fatal: Increased risk of adverse effects with amantadine, dextromethorphan or ketamine.
See Below for More memantine Drug Interactions
Mechanism of Actions
Memantine, a derivative of amantadine, is a noncompetitive N-methyl-D-aspartate (NMDA)-receptor antagonist. It affects transmission of glutamate, the primary excitatory neurotransmitter in the CNS. Glutamate may contribute to the pathogenesis of Alzheimer's disease by overstimulating various glutamate receptors resulting in excitotoxicity and neuronal cell death.
Absorption: Well absorbed (oral); peak plasma concentrations in about 3-8 hr.
Distribution: Protein-binding: Approx 45%.
Metabolism: Partial hepatic metabolism; main metabolites are N-3,5-dimethyl-gludantan and 1-nitroso-3,5-dimethyl-adamantane.
Excretion: Via urine (unchanged; some active renal tubular secretion and reabsorption occurs). 60-100 hr (terminal half-life).
Administration
May be taken with or without food.
Storage Conditions
Oral: Store at 15-30°C (59-86°F).
ATC Classification
N06DX01 - memantine ; Belongs to the class of other anti-dementia drugs.
Storage
Oral: Store at 15-30°C (59-86°F).
Available As
  • Memantine 10 mg
  • Memantine 5 mg
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