Names and pronunciation
(me-man′teen) Ebixa , Namenda, Namenda XR
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Individual generic drug information
Extracted information for memantine only.
(me-man′teen) Ebixa , Namenda, Namenda XR
Source page 839
Func. class.: Anti-Alzheimer’s agent
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Chem. class.: N-methyl-D-aspartate receptor antagonist
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Do not confuse: memantine/methadone
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ACTION: Antagonist action of CNS NMDA receptors that may contribute to the symptoms of Alzheimer’s disease
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USES: Moderate to severe dementia in Alzheimer’s disease
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Extracted information for memantine only.
CONTRAINDICATIONS: Chil- dren, hypersensitivity Precautions: Pregnancy, breastfeeding, renal disease, GU conditions that raise urine pH, seizures, severe hepatic dis- ease, renal failure
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SIDE EFFECTS CNS: Dizziness, confusion, headache, stroke CV: Hypertension, HF GI: Vomiting, constipation HEMA: Anemia INTEG: Rash MISC: Back pain, fatigue, flulike symptoms
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INTERACTIONS Increase/decrease: both products: hydro- CHLOROthiazide, triamterene, cimetidine, quiNIDine, raNITIdine, nicotine; monitor for effect Increase: effect—levodopa, some ergots Decrease: clearance of memantine— products that make urine alkaline (sodium bicarbonate, carbonic anhy- drase inhibitors); monitor for effect • Use cautiously with amantadine, dextromethorphan, ketamine; reac- tion unknown Drug/Food Increase: product level—foods that cause urine alkalinity (fruits, vegetables, nuts, dairy) Drug/Lab Test Increase: alkaline phosphatase Decrease: Hct, HB
Source page 840
Extracted information for memantine only.
DOSAGE AND ROUTES • Adult: PO 5 mg/day, may increase dose in 5-mg increments ≥1-wk intervals over a 3-wk period; recommended target dose is 10 mg bid at wk 4; ext rel 7 mg daily, increased by 7 mg ≥1 wk up to target dose of 28 mg daily Renal dose • Adult: PO CCr 5-29 mL/min, a target of 5 mg bid immediate release or 14 mg/ day extended release
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Available forms: Tabs 5, 10 mg; tab (Namenda Titration Pak) 5, 10 mg; oral sol 2 mg/mL (10 mg/5 mL); cap ext rel 7, 14, 21, 28 mg
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Administer: • Can be taken without regard to meals • Twice a day if dose >5 mg • Dosage adjusted to response no more than q1wk • Ext rel caps: do not crush, chew, di- vide; swallow whole or open and sprin- kle on applesauce • When switching from immediate-re- lease product, begin the ext rel the day after the last dose of immediate-release product. Those on 10 mg bid should be switched to ext rel 28 mg daily • Oral sol: Use device provided; remove dosing syringe, green cap, plastic tube from plastic; attach tube to green cap; open cap by pushing down on cap, turn- ing counterclockwise; remove un- screwed cap; remove seal from bottle, discard; insert plastic tube fully into bottle, screw green cap tightly onto bottle by turning cap clockwise; keeping bottle upright on table, remove lid; with plunger fully depressed, insert tip of syringe into cap; while holding syringe, gently pull up on plunger; remove sy- ringe; invert syringe, slowly press plunger to level that removes large air bubbles; keep plunger in inverted posi- tion; few small air bubbles may be pres- ent
Source page 840
Extracted information for memantine only.
Assess: • Alzheimer’s dementia: affect, mood, behavioral changes; hallucinations, con- fusion, attention, orientation, memory; monitor serum creatinine • Provide assistance with ambulation dur- ing beginning therapy; dizziness may occur • Adverse reactions: patient may be un- able to verbalize reactions
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Evaluate: • Therapeutic response: decrease in confusion, improved mood, maintenance of function, even with no improvement in symptoms
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report side effects: restlessness, psychosis, visual hallucinations, stupor, LOC; may indicate overdose • To use product exactly as prescribed; to avoid alcohol, nicotine • To use oral sol dispenser provided • To avoid OTC, herbal products unless approved by prescriber • That product doesn’t cure Alzheimer’s disease but controls symptoms • Not to smoke or use alcohol • Not to crush, chew ext rel caps, may be opened and sprinkled on apple- sauce; do not mix oral sol with other liquids • That product may cause dizziness HIGH ALERT
Source page 841
Extracted information for memantine only.
PHARMACOKINETICS Rapidly absorbed PO, 44% protein binding, very little metabolism, 57%-82% excreted unchanged in urine, half-life 60-80 hr; peak 3-7 hr (tabs), 9-12 hr (caps)
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Filter the extracted dose blocks for this individual drug.
• Adult: PO 5 mg/day, may increase dose in 5-mg increments ≥1-wk intervals over a 3-wk period; recommended target dose is 10 mg bid at wk 4; ext rel 7 mg daily, increased by 7 mg ≥1 wk up to target dose of 28 mg daily Renal dose
Candidate age grouping · source page 840
• Adult: PO CCr 5-29 mL/min, a target of 5 mg bid immediate release or 14 mg/ day extended release
Candidate age grouping · source page 840