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Memantine Hydrochloride 💊
Related Subjects: | Dementias | Abbreviated Mental Test Score (AMTS)
💡 Key point: NICE recommends memantine as an option for people with:
- Moderate Alzheimer’s disease who are intolerant of or have a contraindication to acetylcholinesterase inhibitors (AChEIs).
- Severe Alzheimer’s disease.
📘 About
- Always check the BNF for latest prescribing advice.
- Memantine is a non-cholinergic treatment for Alzheimer’s disease, particularly useful when AChEIs (donepezil, rivastigmine, galantamine) are unsuitable.
- It is also used off-label in some neurological conditions such as oscillopsia in multiple sclerosis (specialist advice only).
⚙️ Mode of Action
- Uncompetitive NMDA (N-methyl-D-aspartate) receptor antagonist.
- Blocks excessive glutamatergic activity → reduces excitotoxic neuronal damage.
- Thought to help preserve cognitive and functional ability in moderate to severe dementia.
💊 Indications & Example Doses
| Condition | Starting Dose | Titration | Usual Maintenance | Route |
|---|---|---|---|---|
| Alzheimer’s disease (moderate–severe) | 5 mg OD | Increase in 5 mg steps weekly | 20 mg OD | PO |
| Oscillopsia in MS (specialist use) | 10 mg OD | Increase gradually | 40–60 mg/day (specialist guidance only) | PO |
🔄 Interactions
- See BNF for full list.
- Caution with other NMDA antagonists (amantadine, ketamine, dextromethorphan) – additive effects.
⚠️ Cautions
- Renal impairment → reduce dose in moderate–severe CKD.
- Use with caution in patients with history of seizures, recent MI, uncontrolled hypertension, or heart failure.
🚫 Contraindications
- See BNF – none absolute, but avoid if hypersensitive to memantine or excipients.
💥 Side Effects
- Neurological: Dizziness, headache, drowsiness, confusion, unsteadiness.
- GI: Constipation.
- Cardiovascular: Hypertension.
- Rare: Hallucinations, seizures, pancreatitis.
📖 References
- BNF – Memantine
- Cochrane Review – Memantine for dementia
- NICE Technology Appraisal 217: Donepezil, galantamine, rivastigmine, and memantine for Alzheimer’s disease.
📝 Revisions
- September 2025 – Expanded with NICE guidance, titration schedule, and side effect details.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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