Nemdaa
Nemdaa (Memantine 5/10 mg) — Intas Pharma uncompetitive NMDA-receptor antagonist for moderate-severe Alzheimer’s disease. Slow weekly titration to 10 mg twice daily; renal-dose-adjusted.
✓ Medicinsk gennemgået af Morgan Ellis — Apoteksforsker · 8 års erfaring · Sidst gennemgået: maj 2026
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Nemdaa — memantine 5/10 mg (Intas Pharma). Low-affinity uncompetitive NMDA-receptor antagonist for moderate-to-severe Alzheimer’s disease. Often combined with a cholinesterase inhibitor (donepezil). Modest symptomatic benefit; renal-dose adjustment required.
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How memantine works
In Alzheimer’s, glutamate accumulates in the synaptic cleft and chronically over-activates NMDA receptors, contributing to excitotoxicity and cognitive decline. Memantine is a low-affinity uncompetitive NMDA antagonist — it blocks pathological tonic glutamate signalling without blocking the high-amplitude phasic signals needed for normal learning and memory. This selectivity is why it differs from older NMDA antagonists (ketamine, MK-801) which block all NMDA activity and are not tolerable as cognitive drugs.
Dosing — slow titration
| Uge | Dosis |
|---|---|
| 1 | 5 mg once daily (morning) |
| 2 | 5 mg twice daily (morning + evening) |
| 3 | 10 mg morning + 5 mg evening |
| 4 onward | 10 mg twice daily (target dose) |
Slow titration minimises CNS side effects (dizziness, confusion, sedation). The XR formulation (28 mg once daily, where available) is also titrated weekly.
Memantine is renally cleared. Adjust dose by creatinine clearance:
• CrCl >50 mL/min: standard dosing (target 10 mg BID)
• CrCl 30-50 mL/min: target 5 mg BID (10 mg/day total)
• CrCl 5-29 mL/min: 5 mg BID (specialist supervision)
• Dialysis: not well studied — use only if benefit clearly outweighs risk
Bivirkninger
- Common: dizziness, headache, constipation, somnolence, weight gain
- Less common: confusion, hallucinations, hypertension, agitation
- Rare: seizures, psychosis (usually pre-existing predisposition)
Lægemiddelinteraktioner
- Other NMDA antagonists (amantadine, ketamine, dextromethorphan): additive CNS effects — avoid
- Urinary alkalisers (sodium bicarbonate, acetazolamide): reduce renal clearance — monitor
- Hydrochlorothiazide: reduces hydrochlorothiazide levels by ~20% — usually not clinically significant
- Cimetidine, ranitidine, quinidine, nicotine: minor interactions via shared renal cation transport
Ofte stillede spørgsmål
When should memantine be added?
Memantine is approved for moderate-to-severe Alzheimer’s (typically MMSE ≤19 or after a clear functional plateau on donepezil alone). Combination donepezil + memantine in moderate-severe disease has additive benefit.
Bivirkninger?
Generally well tolerated. Common: dizziness, headache, constipation, somnolence. Less common: hallucinations, agitation, confusion (usually transient). Slow titration helps.
Can it be combined with donepezil?
Yes — combination is standard for moderate-severe disease. The two drugs hit different neurotransmitter systems (acetylcholine vs glutamate) and have additive cognitive benefit without major drug interactions.
What about kidney function?
Memantine is renally cleared. Reduce dose if CrCl <50 mL/min. Always monitor renal function in older patients on long-term therapy.
Will it stop or slow disease?
No — memantine is symptomatic, not disease-modifying. It may slow functional decline modestly and reduce care-burden milestones, but does not change underlying neurodegeneration.
Off-label uses?
Memantine has been studied off-label for vascular dementia, OCD augmentation, neuropathic pain, alcohol use disorder, and migraine prophylaxis — evidence is mixed and most uses are research-only.
Lægemiddelinteraktioner?
Few clinically significant interactions. Avoid combination with other NMDA antagonists (amantadine, ketamine, dextromethorphan) — additive CNS effects. Urinary alkalisers (sodium bicarbonate, acetazolamide) reduce memantine clearance and raise levels.
Hvad hvis en dosis glemmes?
Skip the missed dose and continue the normal schedule. If several days are missed, restart at the lower starting dose and re-titrate to avoid CNS side effects.
Hvornår bør det stoppes?
Reassess every 6 months. Stop if no perceived benefit, if side effects outweigh benefit, or in late-stage disease where goals shift to comfort-focused care.
Can I drive?
Initial titration causes dizziness and somnolence in some patients — do not drive until stable on the maintenance dose. Most patients on stable therapy can drive without restriction.
Other Alzheimer’s & Dementia Medications
- Donamem — donepezil + memantine fixed combo
- Alzil — donepezil 5/10 mg
- Donep — donepezil 5/10 mg — Alkem brand
- Donecept — donepezil 5/10 mg — Cipla brand
- Ashvagandha — Ayurvedic adaptogen — adjunctive only, NOT a substitute for prescription dementia therapy
More options in Alzheimer's Treatment
Rangeret efter seneste MedsBase ordrevolumen — hvad andre kunder i denne kategori vælger.
| Styrke | 5 mg, 10 mg |
|---|---|
| Antal | 30 tablet(ter), 60 tablet(ter), 90 tablet(ter) |
| Farmaceutisk form | Tablet/s |
| Producent | Intas Pharma |
| Behandling | Alzheimer's Disease |
| Generisk mærke | Memantine |
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