Tapering Namenda (Memantine) After Catatonia Resolution
Taper memantine over 2-4 weeks with gradual dose reductions of approximately 10% of the original dose per week, monitoring closely for catatonia recurrence at each step.
Recommended Tapering Protocol
The most appropriate approach is to reduce memantine by 10% of the original dose weekly over 2-4 weeks, extrapolating from general deprescribing principles for CNS-active medications in older adults 1. This gradual approach minimizes the risk of symptom recurrence while allowing safe discontinuation.
Specific Tapering Schedule
- Reduce the dose by approximately 2.5-5 mg per week depending on the starting dose 1
- Total taper duration should be 2-4 weeks minimum 1
- Monitor for catatonia recurrence after each dose reduction before proceeding to the next step 2, 3
- If catatonia symptoms re-emerge, return to the previous well-tolerated dose and slow the taper further 2, 3
Critical Monitoring Considerations
Watch specifically for early signs of catatonia recurrence, including:
- Mutism or decreased verbal output 4
- Waxy flexibility or posturing 4
- Immobility or psychomotor retardation 4
- Staring or decreased responsiveness 4
- Rigidity or grimacing 4
Resurgence of catatonia can occur rapidly—within one week of medication changes—so close monitoring during and immediately after tapering is essential 5.
Special Circumstances Requiring Slower Tapers
Consider extending the taper to 4-6 weeks or longer if:
- The patient required higher doses of memantine (>10 mg/day) 4
- Catatonia was severe or prolonged before treatment 6
- The patient has been on memantine for an extended period (>3 months) 1
- There is a history of catatonia recurrence with previous medication changes 5
Managing Catatonia Recurrence During Taper
If catatonia symptoms return during tapering:
- Immediately return to the last effective dose 5, 6
- Consider maintaining that dose for several more weeks before attempting a slower taper 5
- Some patients may require indefinite maintenance treatment if multiple taper attempts fail 6
- Ensure benzodiazepines (particularly lorazepam) remain available as first-line rescue therapy if needed 5, 6
Common Pitfalls to Avoid
- Never abruptly discontinue memantine, as this increases risk of symptom recurrence 5, 6
- Do not use a fixed schedule for all patients—be prepared to slow the taper based on individual response 3, 7
- Avoid tapering during periods of psychosocial stress or other medication changes that could confound assessment 6
- Do not assume successful acute treatment means the patient can be rapidly tapered—some cases require prolonged or indefinite maintenance 6