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Memantine

AEMPS

Non-competitive NMDA receptor antagonist

ATC code: N06DX01

Brand names: Ebixa, Axura, Namenda, Memary

Updated · Methodology

Indications

A

Alzheimer disease

Second line

For moderate-to-severe Alzheimer's disease; at the mild-to-moderate stage the first line is cholinesterase inhibitors (donepezil, rivastigmine, galantamine), while memantine is added at the moderate-to-severe stage or when they are not tolerated, often combined with donepezil ( NG97, 2018). Dose titrated from 5 mg once daily to 20 mg (5 mg per week). The effect is modest – it slows cognitive decline by about 6 months and improves daily functioning, without modifying the underlying disease.

Approved for moderate-to-severe Alzheimer's disease (MMSE 3–14).

Sources

  1. AEMPS: Ficha técnica de Memantina (2024)
  2. Cochrane Database Syst Rev: Memantine for dementia. (2019)
  3. N Engl J Med: Memantine in moderate-to-severe Alzheimer's disease. (2003)

ICD-10: G30 · ICD-11: 8A20

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

F

Memory and concentration enhancement

Not recommended

Memantine is an NMDA receptor antagonist. It is prescribed for moderate-to-severe Alzheimer's disease ( 2018 and NG97 guidelines; the Cochrane review by McShane 2019 confirms benefit only at these stages). For healthy adults as a nootropic or memory enhancer, memantine does not work: clinical studies in people without dementia have not shown improvement in cognitive function. The drug has specific risks: dizziness, confusion, elevated blood pressure, and headache. If memantine was recommended to a healthy person for memory, consider seeking a second opinion.

Sources

  1. AEMPS: Ficha técnica de Memantina (2024)
  2. Cochrane: Ginkgo biloba for cognitive impairment and dementia (2009)
How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

A low-affinity non-competitive NMDA glutamate receptor antagonist. In Alzheimer's disease, chronic excess glutamate release leads to excitotoxicity and neuronal loss. Memantine blocks pathological NMDA receptor activation while preserving physiological function. Does not affect cholinergic system – safely combined with acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine). Half-life 60–80 hours.

Safety

Contraindications

  • Memantine hypersensitivity
  • Severe renal impairment (eGFR under 30)
  • Pregnancy and lactation
  • Age under 18

Serious adverse effects

  • Confusion and hallucinations (especially in Lewy body dementia)
  • Seizures (rare)
  • Heart failure
  • Deep vein thrombosis

Common adverse effects

  • Dizziness
  • Headache
  • Drowsiness
  • Constipation
  • Hypertension
  • Dyspnea

Pregnancy: can you take Memantine?

No data in pregnancy. Not indicated – Alzheimer's in women of reproductive age is exceedingly rare.

Breastfeeding: can you take Memantine?

No data. Not used during lactation.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Take once daily in the morning, with or without food. With eGFR 30–49, maximum dose is 10 mg daily; at eGFR under 30, contraindicated. Assess clinical effect at 3 and 6 months – without stabilization or functional improvement, discuss continuation with the family.
Label mentions14 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

  • MajorDextromethorphan
    «Se debe evitar el uso concomitante de memantina y amantadina, por el riesgo de psicosis farmacotóxica. Los dos compuestos están químicamente relacionados con los antagonistas del NMDA. Esto mismo…»

    AEMPS, section 4.5 · Open on CIMA

  • Moderateanticoagulantesclass named in the label
    «En la experiencia post-comercialización, se ha informado de casos aislados de incremento del cociente internacional normalizado (INR), en pacientes tratados concomitantemente con warfarina. Aunque no…»

    AEMPS, section 4.5 · Open on CIMA

  • Moderateantipsicóticosclass named in the label
    «El mecanismo de acción sugiere que los efectos de la L-dopa, los agonistas dopaminérgicos y los anticolinérgicos pueden aumentar con el tratamiento concomitante de antagonistas del NMDA como…»

    AEMPS, section 4.5 · Open on CIMA

  • Moderatebarbitúricosclass named in the label
    «El mecanismo de acción sugiere que los efectos de la L-dopa, los agonistas dopaminérgicos y los anticolinérgicos pueden aumentar con el tratamiento concomitante de antagonistas del NMDA como…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateDextromethorphan
    «Use with Other N-methyl-D-aspartate (NMDA) Antagonists: The combined use of memantine hydrochloride with other NMDA antagonists (amantadine, ketamine, and dextromethorphan) has not been…»

    FDA, section 7 · Open on DailyMed

  • ModeratePhenytoin
    «Se debe evitar el uso concomitante de memantina y amantadina, por el riesgo de psicosis farmacotóxica. Los dos compuestos están químicamente relacionados con los antagonistas del NMDA. Esto mismo…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateWarfarin
    «En la experiencia post-comercialización, se ha informado de casos aislados de incremento del cociente internacional normalizado (INR), en pacientes tratados concomitantemente con warfarina. Aunque no…»

    AEMPS, section 4.5 · Open on CIMA

  • Donepezil
    «En estudios farmacocinéticos (FC) a dosis únicas realizados en sujetos jóvenes sanos, no se han observado interacciones relevantes principio activo-principio activo entre memantina y…»

    AEMPS, section 4.5 · Open on CIMA

  • Galantamine
    «En un ensayo clínico realizado en sujetos jóvenes sanos, no se han observado efectos relevantes de memantina sobre la farmacocinética de la galantamina.»

    AEMPS, section 4.5 · Open on CIMA

  • Hydrochlorothiazide
    «Cuando se co-administra memantina junto con hidroclorotiazida (HCT) o con cualquier combinación con HCT existe la posibilidad de que se produzca una disminución en los niveles séricos de la HCT.»

    AEMPS, section 4.5 · Open on CIMA

  • Metformin
    «En estudios farmacocinéticos (FC) a dosis únicas realizados en sujetos jóvenes sanos, no se han observado interacciones relevantes principio activo-principio activo entre memantina y…»

    AEMPS, section 4.5 · Open on CIMA

  • Nicotine
    «Otros principios activos, como cimetidina, ranitidina, procainamida, quinidina, quinina y nicotina, que utilizan el mismo sistema de transporte catiónico renal que la amantadina, posiblemente también…»

    AEMPS, section 4.5 · Open on CIMA

  • Quinidine
    «Otros principios activos, como cimetidina, ranitidina, procainamida, quinidina, quinina y nicotina, que utilizan el mismo sistema de transporte catiónico renal que la amantadina, posiblemente también…»

    AEMPS, section 4.5 · Open on CIMA

From other drugs’ labels

  • Galantamine
    «Memantina, un antagonista del receptor N-metil-D-aspartato (NMDA), no tuvo efecto sobre la farmacocinética de galantamina de 16 mg cápsulas de liberación prolongada una vez al día en estado…»

    AEMPS, section 4.5 · Open on CIMA

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Frequently asked

What is Memantine used for?

Memantine is evaluated for the following indications with varying evidence strength: Alzheimer disease (evidence tier A), Memory and concentration enhancement (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Memantine?

Common side effects of Memantine (≥ 1 in 100): Dizziness, Headache, Drowsiness, Constipation, Hypertension, Dyspnea. See the Safety section for uncommon and serious reactions.

Is Memantine safe during pregnancy?

No data in pregnancy. Not indicated – Alzheimer's in women of reproductive age is exceedingly rare.

Is Memantine compatible with breastfeeding?

No data. Not used during lactation.

Who should not take Memantine?

Memantine is contraindicated in: Memantine hypersensitivity; Severe renal impairment (eGFR under 30); Pregnancy and lactation; Age under 18. Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

Other drugs in this group

Methylphenidate, Mirtazapine, Moclobemide, Noopept (N-phenylacetyl-L-prolylglycine ethyl ester), Phosphatidylserine, Trazodone, Bupropion, Fluoxetine