What is the recommended titration schedule for Namenda (memantine)?

Namenda (Memantine) Titration Schedule

The recommended titration schedule for Namenda (memantine) is to start with 5 mg once daily and increase in 5 mg increments at weekly intervals to a target dose of 20 mg/day (10 mg twice daily). 1

Standard Titration Schedule

• Week 1: 5 mg once daily 1
• Week 2: 10 mg/day (5 mg twice daily) 1
• Week 3: 15 mg/day (5 mg in the morning and 10 mg in the evening) 1
• Week 4 and beyond: 20 mg/day (10 mg twice daily) - maintenance dose 1

Special Considerations

Renal Impairment

• For patients with severe renal impairment (creatinine clearance 5-29 mL/min), the target dose should be reduced to 10 mg/day (5 mg twice daily) 1
• No dose adjustment is needed for mild to moderate renal impairment 1

Missed Doses

• If a patient misses a single dose, they should not double up on the next dose 1
• If treatment is interrupted for several days, dosing should be restarted at lower doses and retitrated according to the schedule 1

Alternative Formulations

Extended-Release Formulation

• Namenda XR (extended-release) is available as a once-daily 28 mg capsule 2
• The extended-release formulation may improve medication adherence due to once-daily dosing 2
• Extended-release capsules can be opened and contents sprinkled on applesauce for patients with difficulty swallowing 2

Clinical Considerations

• The minimum recommended interval between dose increases is one week to minimize side effects 1
• Memantine can be taken with or without food 1
• The most common adverse effects include dizziness, headache, confusion, and constipation 1
• Once-daily dosing has been shown to have similar safety and tolerability profiles to twice-daily dosing in clinical studies 3

Common Pitfalls to Avoid

• Increasing the dose too rapidly (less than weekly intervals) may increase the risk of adverse effects 1
• Failing to adjust the dose for patients with severe renal impairment can lead to drug accumulation 1
• After treatment interruption, restarting at the maintenance dose rather than retitrating can increase side effects 1
• Mixing the oral solution with other liquids is not recommended 1