From the Guidelines
Namenda (memantine) should be considered for patients with moderate to severe Alzheimer's disease, as it may temporarily improve symptoms or slow their progression. When choosing between pharmacologic agents for dementia treatment, clinicians should prioritize tolerability, adverse effect profile, ease of use, and cost of medication, as evidence is insufficient to compare the effectiveness of different agents 1. The medication is approved by the FDA for the treatment of moderate to severe Alzheimer disease, and patients with mild vascular dementia have shown mild benefit from memantine. However, major contraindications include uncontrolled asthma, angle-closure glaucoma, the sick sinus syndrome, and left bundle-branch block.
Some key points to consider when prescribing Namenda include:
- Starting with a low dose of 5 mg once daily and gradually increasing to a target dose of 10 mg twice daily (20 mg total daily dose) to minimize side effects
- Common side effects such as dizziness, headache, confusion, and constipation
- Potential use in combination with cholinesterase inhibitors like donepezil (Aricept)
- Importance of regular dosing and consulting a healthcare provider before stopping the medication
- Contraindications in patients with severe renal impairment and the need for dose adjustments in moderate renal impairment. According to the American College of Physicians and the American Academy of Family Physicians guideline, the choice of pharmacologic agents should be based on individual patient factors, rather than a specific medication being recommended over others 1.
From the FDA Drug Label
Memantine hydrochloride is an N-methyl-D-aspartate (NMDA) receptor antagonist indicated for the treatment of moderate to severe dementia of the Alzheimer’s type. The main use of Namenda, also known as memantine, is for the treatment of moderate to severe dementia of the Alzheimer’s type.
From the Research
Overview of Namenda
- Namenda, also known as memantine, is a moderate-affinity, uncompetitive, voltage-dependent, NMDA-receptor antagonist used in the treatment of Alzheimer's disease 4.
- It is approved in the US and the EU for the treatment of patients with moderate to severe dementia of the Alzheimer's type 4.
Efficacy of Namenda
- Memantine has been shown to modify the progressive symptomatic decline in global status, cognition, function, and behavior exhibited by patients with moderate to severe Alzheimer's disease in four 12- to 28-week trials 4.
- In patients with mild to moderate Alzheimer's disease, data from three 24-week trials are equivocal, although meta-analyses indicate beneficial effects on global status and cognition 4.
- Combination therapy with memantine plus donepezil improved outcomes more than donepezil plus placebo in all four domains (function, cognition, behavior, and global change) 5, 6.
Safety and Cost-Effectiveness of Namenda
- Memantine is generally well tolerated, with adverse events occurring with a similar incidence to that reported with placebo 5, 6.
- In modelled cost-effectiveness analyses, memantine was dominant to no therapy in regard to cost per quality-adjusted life-year (QALY) gained, and the combination of memantine plus donepezil was dominant to donepezil therapy alone in regard to QALYs gained when treatment periods exceeded 1 year in patients with moderate to severe disease 5, 6.
- The probability that memantine is cost-effective in a moderate to severe cohort compared with best supportive care at a willingness-to-pay of £30,000 per QALY is 38% 7.