II. Dosing

  1. Memantine (Namenda, Ebixa in Europe)
    1. Start: 5 mg orally daily
    2. Titrate to: 10 mg orally twice daily (20 mg daily)
    3. Could be dosed once daily due to Memantine's long half life (with equivalent efficacy to the XR preparation)
      1. Memantine regular preparation will be generic in 2015
      2. Memantine regular will be discontinued by manufacturer as of August 2014 (one year before generics are available)
  2. Memantine ER (Namenda XR)
    1. Start 7 mg orally daily
    2. Titrate daily dose by 7 mg on a weekly basis to maximum of 28 mg daily (maximum 14 mg daily in renal Impairment)

III. Indications: Moderate to severe Dementia

  1. Consider as alternative to cholinesterase inhibitor (e.g. Aricept) if side effects limit use
    1. Memantine may be better tolerated than cholinesterase inhibitors
  2. Previously added on to cholinesterase inhibitor protocol for added benefit
    1. Combination therapy no longer recommended due to low efficacy (only helped 1 in 12)
    2. Combination therapy is associated with gastrointestinal side effects, Bradycardia and Syncope

IV. Efficacy

  1. Can improve cognition and function

V. Pharmacokinetics

  1. Half-life (Memantine): 60-80 hours

VI. Adverse Effects

VII. References

  1. (2014) Presc Lett 21(5): 26
  2. (2013) Presc Lett 20(7): 41
  3. (2012) Presc Lett 19(5): 28
  4. Tariot (2004) JAMA 291:317-24 [PubMed]
  5. Howard (2012) N Engl J Med 366:893-903 [PubMed]

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Cost: Medications

memantine (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
MEMANTINE 5-10 MG TITRATION PK Generic $0.88 each
MEMANTINE HCL 10 MG TABLET Generic $0.29 each
MEMANTINE HCL 5 MG TABLET Generic $0.28 each
namenda (on 1/1/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
NAMENDA 10 MG TABLET Generic $0.29 each
NAMENDA 2 MG/ML SOLUTION $1.94 per ml
NAMENDA 5 MG TABLET Generic $0.28 each
NAMENDA 5-10 MG TITRATION PK Generic $0.88 each
NAMENDA XR 14 MG CAPSULE $11.32 each
NAMENDA XR 21 MG CAPSULE $11.53 each
NAMENDA XR 28 MG CAPSULE $11.37 each
NAMENDA XR 7 MG CAPSULE $11.52 each
NAMENDA XR TITRATION PACK $11.52 each