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Memantine

Class
Anti-dementia agents
Subclass
NMDA receptor antagonists
Substance name
Memantine hydrochloride
Brand names
Namenda®
Common formulations
Tablet
See also
Memantine ER (Namenda XR®)
Dosage and administration
Adults patients
Treatment
Alzheimer's disease • Moderate-to-severe
•
Start at: 5 mg PO daily
•
Maintenance: 10 mg PO BID
•
Maximum: 20 mg per day
Titrate in 5 mg increments weekly.
Catatonia • Off-label
•
5-20 mg PO daily
Dementia with Lewy bodies • Mild-to-moderate • Off-label
•
20 mg PO daily
Adjunctive treatment
OCD • Off-label
•
5-10 mg PO daily
Administered in combination with SSRIs.
Schizophrenia • Off-label
•
Start at: 5-10 mg PO daily
•
Maintenance: 20 mg PO daily
Prevention
Prevention of migraine attacks • Off-label
•
10-20 mg PO daily
Indications for use
Labeled indications
Adults
•
Treatment of Alzheimer's disease (moderate-to-severe)
Off-label indications
Adults
•
Treatment of catatonia
•
Treatment of dementia with Lewy bodies (mild-to-moderate)
•
Adjunctive treatment for OCD
•
Adjunctive treatment for schizophrenia
•
Prevention of migraine attacks
Safety risks
Contraindications
Hypersensitivity to memantine or its components
Warnings and precautions
Increased serum memantine levels
•
Use caution in patients with conditions raising urinary pH and decreasing the urinary elimination of memantine, such as renal tubular acidosis or severe UTIs.
Specific populations
Renal impairment
CrCl ≥ 30 mL/min
•
Use acceptable. No dose adjustment required.
CrCl < 30 mL/min
•
Maximal dose of 5 mg. Do not exceed frequency of BID.
Renal replacement therapy
Any modality
•
Dose as in CrCl < 30 mL/min.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
Use acceptable. No dose adjustment required.
Child-Pugh C (severe)
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B2
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Hypertension, hypotension, aggressive behavior, influenza virus infection, abdominal pain, anxiety, back pain, confusion, constipation, cough, depression, diarrhea, diarrhea, dizziness, dyspnea, fatigue, hallucinations, headache, somnolence, urinary incontinence, vomiting, vomiting, weight gain
Uncommon < 1%
•
Seizure
Unknown frequency
•
Acute pancreatitis, agranulocytosis, cholestasis, ↓ WBC count, ↓ platelet count, heart failure, hepatitis, pneumonia, pancytopenia, renal failure, skin rash, Stevens-Johnson syndrome, thrombotic thrombocytopenic purpura, toxic epidermal necrolysis
Interactions
Drug(s)
Check Interactions
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