Memantine

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Contents

[edit] BRAND NAMES

[edit] STRUCTURE

Memantine.jpg

[edit] MECHANISM OF ACTION

Persistent activation of central nervous system N-methyl-D-aspartate (NMDA) receptors by the excitatory amino acid glutamate has been hypothesized to contribute to the symptomatology of Alzheimer’s disease.

Memantine is a low affinity NMDA receptor antagonist which binds preferentially to the NMDA receptor-operated cation channels.

There is no evidence that memantine prevents or slows neurodegeneration in patients with Alzheimer’s disease

[edit] INDICATIONS

Memantine is indicated for the treatment of moderate to severe dementia of the Alzheimer’s type

[edit] DOSAGE

  • May be taken with or without food
  • Initial dose is 5 mg once daily. Increase dose in 5 mg increments to a maintenance dose of 10 mg twice daily. A minimum of 1 week of treatment with the previous dose should be observed before increasing the dose.
  • Severe renal impairment: recommended dose is 5 mg twice daily

[edit] CONTRAINDICATIONS

Patients with known hypersensitivity to memantine hydrochloride

[edit] WARNINGS AND PRECAUTIONS

Conditions that raise urine pH may decrease the urinary elimination of memantine, resulting in increased plasma levels of memantine.

[edit] INTERACTIONS

Drugs that Make the Urine Alkaline
The clearance of memantine was reduced by about 80% under alkaline urine conditions at pH 8.
Therefore, alterations of urine pH towards the alkaline condition may lead to an accumulation of the drug with a possible increase in adverse effects. Urine pH is altered by diet, drugs (e.g. carbonic anhydrase inhibitors, sodium bicarbonate) and clinical state of the patient (e.g. renal tubular acidosis or severe infections of the urinary tract). Hence, memantine should be used with caution under these conditions.


Use with Other N-methyl-D-aspartate (NMDA) Antagonists
The combined use of NAMENDA with other NMDA antagonists (amantadine, ketamine, and dextromethorphan) has not been systematically evaluated and such use should be approached with caution.

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category B (US). There are no adequate and well-controlled studies of memantine in pregnant women. thus it should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • Nursing Mothers : It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when memantine is administered to a nursing mother.

[edit] SIDE EFFECTS

Most common adverse reactions (≥ 5 % and greater than placebo) are dizziness, headache, confusion and constipation.

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

[edit] REFERENCES

Alzheimer/Dementia
Anticholinesterases Donepezil (Aricept, Memac)   Galantamine (Reminyl)   Rivastigmine (Oral) (Exelon)   Rivastigmine (Transdermal) (Exelon Patch)
Glutamatergic NMDA receptor antagonists Memantine (Ebixa)
Psychostimulants and nootropics Aniracetam   Choline   Citicoline   Ginkgo biloba   Piracetam