Can Namenda (memantine) be given to a patient on comfort care?

Memantine (Namenda) in Comfort Care

Yes, memantine (Namenda) can be continued for patients on comfort care as it does not interfere with comfort goals and may help manage certain symptoms, provided it aligns with the patient's overall care plan.

Considerations for Memantine in Comfort Care

Role of Memantine

• Memantine is an NMDA receptor antagonist approved for moderate to severe Alzheimer's disease that can help modify progressive symptomatic decline in cognition, function, and behavior 1
• It works by inhibiting excessive calcium influx induced by chronic overstimulation of the NMDA receptor 1

Medication Management in Comfort Care

• Medications for symptom palliation used before initiating comfort care should be continued unless they are ineffective or have distressing side effects 2
• Medications that are either inconsistent with or irrelevant to the goal of patient comfort can be discontinued 2
• The primary focus should be on alleviating pain and suffering with appropriate analgesia and sedation 2

Benefits of Continuing Memantine

• In patients with moderate to severe Alzheimer's disease, memantine has demonstrated significant reductions in functional and cognitive decline 3, 4
• Memantine is generally well tolerated with an acceptable side effect profile, making it suitable for continuation in comfort care settings 1, 5
• Abrupt discontinuation of medications like memantine could potentially lead to worsening symptoms, which may increase patient discomfort 2

When to Consider Discontinuation

• If memantine is causing adverse effects that exacerbate patient suffering, then reduction or withdrawal should be considered 2
• If the patient has difficulty swallowing and memantine administration becomes burdensome, discontinuation may be appropriate 2

Special Considerations

Monitoring and Assessment

• Regular assessment of the patient's comfort level should guide decisions about continuing or discontinuing memantine 2
• Monitor for any signs of discomfort that might be related to medication administration 2

Family Communication

• The care team should provide regular information updates to the family about the patient's condition and medication management 2
• Family members often need reassurance about medication decisions in comfort care settings 2

Cost Considerations

• If cost is a concern, consider available formulations (oral solution may be easier to administer than tablets for patients with swallowing difficulties) 6

Common Pitfalls to Avoid

• Avoid automatically discontinuing all medications when transitioning to comfort care - each medication should be evaluated individually for its contribution to patient comfort 2
• Don't confuse memantine with neuromuscular blocking agents (NMBAs), which are generally recommended to be discontinued at the end of life 2
• Remember that memantine is not an analgesic, so appropriate pain management should still be provided separately 2

In summary, memantine can be continued in patients on comfort care if it contributes to patient comfort and quality of life. The decision should be based on the individual's condition, symptoms, and goals of care, with the primary focus on maximizing comfort.