Memantine and Donepezil (Oral)

Patients with moderate to severe Alzheimer's induced dementia often find relief from the symptoms of memory loss and other mental changes by taking the combination of memantine and donepezil.

Overview

The prescription-strength combination of memantine and donepezil has proven an effective treatment of the dementia symptoms often associated with moderate to severe Alzheimer's. While there is currently no cure for this disease, the combination of memantine and donepezil has yielded successful results in treating memory loss, cognitive ability, and the patient's overall level of functioning.

This drug is taken once a day, at bedtime, with or without food, according to the patient's preference. If the patient is unable to swallow the capsule whole, it may be opened and the contents sprinkled onto a soft food such as applesauce or pudding. In such cases, the mixture containing the medication must be swallowed immediately without being chewed.

It is possible to overdose on the combination of memantine and donepezil and patients and their caregivers should familiarize themselves with the signs and symptoms of overdose. Should an overdose occur, contact 911 or seek immediate emergency help right away.

Do not alter the way in which memantine and donepezil combination is taken without first discussing such alterations with your doctor. If you do not think that it is working effectively or as expected, talk to the prescribing physician about your concerns prior to making any changes to how you take the medication.

The combination drug of memantine and donepezil comes in these two dosage delivery methods:

  • Delayed Release Capsule
  • Extended Release Capsule

Condition(s) Treated:

  • Dementia related to Alzheimer's Disease

Type of Medicine:

  • Cholinesterase Inhibitor

Side Effects

Similar to most medications, there are certain unwanted side effects that can occur in addition to the desired outcomes. Patients and their caregivers are encouraged to recognize the difference between serious side effects that require immediate medical attention and those that will likely go away on their own. If patients are ever in doubt of the appropriate action to take when experiencing a side effect that is not listed here they should call their doctor or pharmacist for further medical advice.

Notify your doctor of all medications that you are currently taking, and have recently stopped taking. When relaying this information, it is important to include both prescription and non-prescription drugs along with any herbal remedies or vitamin and mineral supplements that you may take.

Do not start taking any new medication without first discussing this with your doctor.

Your doctor should know of all allergies that you may have, including allergic reactions to other medications, food, animals, cleaning products, or other substances. Such allergies may affect the way in which your system reacts to the memantine and donepezil combination.

Inform your doctor of your complete medical history as certain other conditions may affect the way that your system reacts to this medication. The use of memantine and donepezil combination may also worsen certain other conditions.

If any of the following side effects and symptoms should occur it may be a sign of a more serious issue, so contact the prescribing physician right away:

An unknown incidence of occurrence:

  • Trouble breathing
  • Decreased urination
  • Slow or irregular heartbeat
  • Bloody or black, tarry stools
  • Vomiting blood or a substance that resembles coffee grounds
  • Severe stomach pain
  • Seizures
  • Sweating
  • Lightheadedness, dizziness, or fainting
  • Unexplained tiredness
  • Chest pain or discomfort
  • Pain in the lower abdomen or sides

As the patient's system adjusts to the presence of the memantine and donepezil combination, they may experience certain effects that will likely go away on their own after a few days. The prescribing physician can offer some tips and strategies for minimizing these side effects should they occur. Any reaction that lingers for longer than a few days or becomes worse may be a sign of a more serious problem and the prescribing physician should be informed:

An unknown incidence of occurrence:

  • Decreased appetite
  • Nausea
  • Constipation
  • Vomiting
  • Diarrhea

It is also possible for the patient to experience other side effects that are not listed here. If any of the symptoms become significant or a cause for concern, notify the doctor as soon as possible. Any symptoms that linger for more than a few days, no matter how severe, should be discussed with the prescribing physician. If there is any doubt as to the severity of the symptoms and whether they require further medical attention, it is always best to err on the side of caution.

Dosage

The dosage information outlined below represents the typical amounts that are prescribed in most cases; however, dosages may differ depending on the situation. Always follow the instructions provided with the prescription even if they differ from what is stated below. It is important to take this medication exactly as prescribed in order for it to be effective.

The memantine and donepezil combination may be taken with a meal or on an empty stomach, according to the patient's preference.

This medication must be taken whole and cannot be chewed, broken up, or crushed. If you experience difficulty with swallowing the medication, speak with your pharmacist or doctor for further medical advice.

One option for patients who experience difficulty swallowing the medication is to sprinkle the medicine on a soft food such as applesauce. This must be swallowed immediately, and not chewed.

Typically, a single pill will contain the daily dose for this medication, although your prescription may vary.

  • Take the memantine and donepezil combination every day at bedtime.

Patients who inadvertently miss a dose should take it as soon as they realize that it has been skipped. Do not ever take two pills in order to make up for a skipped dose. If you have missed your scheduled dose and are unsure what to do, contact your pharmacist for further medical advice.

Major Drug Interactions:

Similar to many prescription medications, memantine and donepezil combination is contraindicated for use with certain other drugs. Your doctor may change a medication that you are taking in order to avoid the potential reactions that may occur when they are used with memantine and donepezil combination. Other medicines may cause an increased risk of potential negative side effects and the prescribing physician may alter the way in which one or both of the medications are taken.

The use of memantine and donepezil combination with any of the medications listed below is typically not advised as the medications are contraindicated for use. Patients who are taking one of these drugs may have their doctor change the medicine to an alternative prior to starting the memantine and donepezil combination course of treatment:

  • Terfenadine
  • Bepridil
  • Saquinavir
  • Dronedarone
  • Piperaquine
  • Ketoconazole
  • Amifampridine
  • Pimozide
  • Ziprasidone
  • Posaconazole
  • Fluconazole
  • Sparfloxacin
  • Cisapride
  • Thioridazine
  • Amisulpride
  • Mesoridazine

While the use of memantine and donepezil combination is not recommended for use with the following drugs, it may still represent the most effective course of treatment. Your doctor may alter the way in which you take one or both of the drugs in order to minimize the chance of unwanted side effects:

  • Abiraterone
  • Voriconazole
  • Acetophenazine
  • Vilanterol
  • Acrivastine
  • Vemurafenib
  • Alfentanil
  • Vandetanib
  • Amantadine
  • Umeclidinium
  • Amdinocillin
  • Tropicamide
  • Amineptine
  • Triprolidine
  • Amiodarone
  • Trimipramine
  • Amitriptylinoxide
  • Triflupromazine
  • Amphetamine
  • Trazodone
  • Anagrelide
  • Toremifene
  • Antazoline
  • Tizanidine
  • Aripiprazole
  • Timiperone
  • Asenapine
  • Tibolone
  • Atazanavir
  • Thonzylamine
  • Atropine
  • Thiopropazate
  • Azelastine
  • Theophylline
  • Azlocillin
  • Terbinafine
  • Baclofen
  • Telithromycin
  • Belladonna Alkaloids
  • Telaprevir
  • Benzphetamine
  • Tamoxifen
  • Bornaprine
  • Tacrine
  • Bromodiphenhydramine
  • Sultamicillin
  • Brompheniramine
  • Sulbenicillin
  • Bupivacaine
  • Succinylcholine
  • Bupropion
  • Sorafenib
  • Butorphanol
  • Sodium Phosphate, Monobasic
  • Butylscopolamine
  • Sodium Phosphate
  • Carbinoxamine
  • Sibutramine
  • Chloroquine
  • Sertraline
  • Chlorpheniramine
  • Scopolamine
  • Chlorpromazine
  • Ritonavir
  • Cinacalcet
  • Rilpivirine
  • Ciprofloxacin
  • Ranolazine
  • Clarithromycin
  • Quinidine
  • Clemizole
  • Quetiapine
  • Clobazam
  • Protriptyline
  • Cloxacillin
  • Propizepine
  • Cobicistat
  • Propicillin
  • Codeine
  • Propafenone
  • Crizotinib
  • Promestriene
  • Cyclizine
  • Prochlorperazine
  • Cyclopentolate
  • Procainamide
  • Cyproheptadine
  • Polyestradiol Phosphate
  • Darifenacin
  • Pivampicillin
  • Degarelix
  • Pirenzepine
  • Demecarium
  • Piperacillin
  • Deslorelin
  • Pinaverium
  • Dexbrompheniramine
  • Physostigmine
  • Dextroamphetamine
  • Phenylpropanolamine
  • Dibenzepin
  • Phenindamine
  • Dicyclomine
  • Periciazine
  • Diethylstilbestrol
  • Perazine
  • Dihydrocodeine
  • Pentamidine
  • Dimethindene
  • Penicillin G
  • Diphenylpyraline
  • Pazopanib
  • Distigmine
  • Paroxetine
  • Dofetilide
  • Paliperidone
  • Domperidone
  • Oxycodone
  • Dothiepin
  • Oxatomide
  • Doxylamine
  • Orphenadrine
  • Duloxetine
  • Ondansetron
  • Echothiophate
  • Olanzapine
  • Efavirenz
  • Octreotide
  • Emedastine
  • Norfloxacin
  • Epinastine
  • Niaprazine
  • Erythromycin
  • Nelfinavir
  • Esterified Estrogens
  • Nalidixic Acid
  • Estramustine
  • Nafcillin
  • Estrone
  • Moxifloxacin
  • Ethinyl Estradiol
  • Moricizine
  • Etravirine
  • Milnacipran
  • Felbamate
  • Mezlocillin
  • Fesoterodine
  • Metopimazine
  • Flavoxate
  • Methotrimeprazine
  • Floxacillin
  • Methicillin
  • Fluoxetine
  • Methazolamide
  • Fluvoxamine
  • Methamphetamine
  • Foscarnet
  • Mestranol
  • Galantamine
  • Mepenzolate
  • Gemifloxacin
  • Melitracen
  • Gonadorelin
  • Mefenamic Acid
  • Granisetron
  • Mebhydrolin
  • Halofantrine
  • Lumefantrine
  • Hetacillin
  • Lofepramine
  • Homatropine
  • Lisdexamfetamine
  • Hydromorphone
  • Lidocaine
  • Hydroxyamphetamine
  • Itraconazole
  • Levomilnacipran
  • Hyoscyamine
  • Levocabastine
  • Iloperidone
  • Lapatinib
  • Indalpine
  • Ketamine
  • Isoflurophate
  • Mebeverine
  • Isopropamide
  • Haloperidol
  • Ivabradine
  • Isoniazid
  • Ketotifen
  • Iprindole
  • Leuprolide
  • Imipramine
  • Levofloxacin
  • Ibutilide
  • Levorphanol
  • Hydroxychloroquine
  • Lindane
  • Hydroquinidine
  • Lithium
  • Hydrocodone
  • Loxapine
  • Histrelin
  • Meclizine
  • Guanidine
  • Mefloquine
  • Goserelin
  • Melperone
  • Glycopyrrolate
  • Meperidine
  • Gatifloxacin
  • Methadone
  • Fosphenytoin
  • Methantheline
  • Formoterol
  • Methdilazine
  • Fluphenazine
  • Methixene
  • Flunarizine
  • Methylphenidate
  • Flecainide
  • Metronidazole
  • Fingolimod
  • Mifepristone
  • Fentanyl
  • Mizolastine
  • Famotidine
  • Morphine
  • Ethopropazine
  • Nafarelin
  • Estropipate
  • Nalbuphine
  • Estriol
  • Nefazodone
  • Estradiol
  • Neostigmine
  • Escitalopram
  • Nilotinib
  • Eribulin
  • Nortriptyline
  • Enflurane
  • Ofloxacin
  • Eliglustat
  • Olopatadine
  • Edrophonium
  • Opipramol
  • Ebastine
  • Oxacillin
  • Droperidol
  • Oxybutynin
  • Doxepin
  • Oxymorphone
  • Dorzolamide
  • Panobinostat
  • Dolasetron
  • Pasireotide
  • Dixyrazine
  • Peginterferon Alfa-2b
  • Disopyramide
  • Penicillin V
  • Diphenhydramine
  • Pentazocine
  • Dimenhydrinate
  • Perflutren Lipid Microsphere
  • Difenoxin
  • Perphenazine
  • Dienestrol
  • Pheniramine
  • Dicloxacillin
  • Phenyltoloxamine
  • Dextromethorphan
  • Pimavanserin
  • Dexchlorpheniramine
  • Pipamperone
  • Desvenlafaxine
  • Pipotiazine
  • Desipramine
  • Pitolisant
  • Delamanid
  • Pizotyline
  • Dasatinib
  • Probucol
  • Dabrafenib
  • Procaine
  • Cyclosporine
  • Promazine
  • Cyclobenzaprine
  • Promethazine
  • Cyclacillin
  • Propantheline
  • Conjugated Estrogens
  • Propiverine
  • Cocaine
  • Propoxyphene
  • Clozapine
  • Pyrilamine
  • Clomipramine
  • Quinestrol
  • Clidinium
  • Quinine
  • Clemastine
  • Remifentanil
  • Citalopram
  • Risperidone
  • Cinnarizine
  • Rivastigmine
  • Cimetropium
  • Sertindole
  • Chlorphenoxamine
  • Sevoflurane
  • Chlorotrianisene
  • Sodium Bicarbonate
  • Chlorambucil
  • Sodium Phosphate, Dibasic
  • Carbenicillin
  • Solifenacin
  • Butriptyline
  • Sotalol
  • Buserelin
  • Sufentanil
  • Buprenorphine
  • Sulpiride
  • Buclizine
  • Sunitinib
  • Bromperidol
  • Tacrolimus
  • Brinzolamide
  • Tapentadol
  • Bepotastine
  • Telavancin
  • Benperidol
  • Temocillin
  • Bedaquiline
  • Tetrabenazine
  • Bacampicillin
  • Thiethylperazine
  • Azithromycin
  • Thioproperazine
  • Azatadine
  • Tianeptine
  • Atomoxetine
  • Ticarcillin
  • Astemizole
  • Tiotropium
  • Arsenic Trioxide
  • Tolterodine
  • Apomorphine
  • Tramadol
  • Anisotropine
  • Trifluoperazine
  • Ampicillin
  • Trimeprazine
  • Amoxapine
  • Tripelennamine
  • Amitriptyline
  • Triptorelin
  • Aminophylline
  • Trospium
  • Amdinocillin Pivoxil
  • Valethamate
  • Ambenonium
  • Vardenafil
  • Alfuzosin
  • Venlafaxine
  • Alcaftadine
  • Vinflunine
  • Aclidinium
  • Vorinostat
  • Acetazolamide
  • Zuclopenthixol

The drug noted below has been known to cause unwanted side effects when used with memantine and donepezil combination, however, it may be the best and most effective course of treatment for the patient:

  • Ramelteon

There are certain foods that should be avoided while taking this medication. It is also important to make your physician aware of any lifestyle habits that you may have, such as alcohol and tobacco use, that can affect the way that memantine and donepezil combination interacts with your system. Inform the prescribing physician of all drugs that you are currently taking as well as those that you have previously stopped taking. When relaying this information be sure to include all prescription and non-prescription drugs as well as herbal remedies, and the vitamin and mineral supplements that you use.

Avoid the following two food items while taking memantine and donepezil combination:

  • Grapefruit Juice
  • Bitter Orange

Patients who are also affected by one or more of the medical conditions listed below will need to work closely with their doctor to ensure that no negative reactions occur while you are taking memantine and donepezil combination:

  • Asthma
  • Lung disease
  • Peptic ulcers
  • Seizures
  • Urinary tract blockage
  • Difficult urination
  • Heart problems
  • Kidney disease

Warnings

During the memantine and donepezil combination course of treatment, regular diagnostic testing will likely be ordered by the physician. Due to the seriousness of the condition that is treated by memantine and donepezil combination, it is important that all follow-up appointments are kept and that all diagnostic testing, such as blood tests and urine screenings, is undergone as scheduled.

Prior to any emergency treatment, dental care, or any type of surgery, make certain that the medical provider (doctor or dentist) is made aware that the patient is currently taking memantine and donepezil combination. The use of this medication can alter the effects of many drugs that are utilized during medical, emergency, and dental procedures and this use may cause complications.

Bowel or stomach bleeding can occur during the memantine and donepezil combination course of treatment, and this serious condition requires immediate medical attention. If any of the following symptoms occur notify your prescribing physician at once:

  • Bloody stools
  • Significant stomach pain
  • Severe constipation
  • Vomiting a substance that resembles coffee grounds in appearance
  • Vomiting blood
  • Black, tarry stools

In some instances patients taking memantine and donepezil in combination may develop recurring and serious issues manifested with the following symptoms:

  • Weight loss
  • Loss of appetite, diarrhea
  • Severe vomiting
  • Nausea

It is possible to overdose on the combination of memantine and donepezil and patients and their caregivers should familiarize themselves with the signs and symptoms of overdose as well as the action to take should they occur:

  • Severe nausea
  • An increase in saliva production in the mouth
  • Difficulty breathing
  • Seizures
  • Muscle weakness
  • Excessive sweating
  • Vomiting
  • Decreased heartbeat
  • A decrease in blood pressure

Seek immediate emergency medical care if the above occur.

Do not begin to take any medications, both prescription and non-prescription, without first discussing such changes with your doctor.

Do not change the way in which you take memantine and donepezil without first discussing such alterations with the prescribing physician.

Storage

It is always best practice to store all medications in the original packaging. Memantine and donepezil combination should be stored at room temperature in a low-moisture environment that does not receive direct light. Do not expose this medication to extreme cold or heat, do not allow it to freeze.

It is important to keep this and all medications out of the reach of small children and pets.

At the conclusion of your course of therapy safely and appropriately dispose of all unused, excess, and expired medications. If you are uncertain about the safe disposal methods necessary for this drug, consult with your pharmacist.

Summary

The prescription-strength combination of memantine and donepezil has proven an effective treatment of the dementia symptoms often associated with moderate to severe Alzheimer's. While there's currently no cure for this disease, the combination of memantine and donepezil has yielded successful results in treating memory loss, cognitive ability, and the patient's overall level of functioning.

This medication can cause overdose and it is important that patients and their caregivers familiarize themselves with the signs and symptoms of overdose. Should these symptoms occur, notify 911 or seek emergency medical treatment right away.

Do not change or alter the way that this medication is taken unless advised to do so by the prescribing physician.