Namenda Medication discussion

1. Namenda
Karen Anderson
MSNE 5356 Advanced Pharmacology

2. Memantine (Namenda)
• This medication is used to treat the
pathophysiological condition of Alzheimer’s
Disease. The drug classification of Namenda is an
NMDA receptor antagonist, its primary treatment
is for cognitive impairment and the daily
recommended dose in milligrams is 5-20
(Vallerand & Sanoski, 2014).

4. Pathophysiology of Alzheimer’s
• The pathophysiological condition of Alzheimer’s disease (AD) is the
most common cause of dementia with cases reported in
approximately 80% of dementia.
• AD is diagnosed by clinicians based on pathologic changes in the
brain namely the formation of neurofibrillary tangles, senile
plaques, cortical atrophy as well as significant loss of neurons
which cause a decrease in acetylcholine and excessive stimulation
of glutamate leading to neuronal toxicity. The number one area
affected by these changes is the brain. The areas of the brain
responsible for memory, behavior, and motor skills which are the
hippocampus cerebral cortex, and amygdala show steady
deterioration (Arcangelo & Peterson, 2013).

5. Intended Drug Response
• The intended drug response patients hope to experience while taking
Namenda is a decrease or slowing down of the progressive symptoms of
Alzheimer’s disease.
• Pathologically a person with AD has high levels of glutamate which
causes a decline in functionality. Namenda protects brain cells against
the sustained onslaught of excess glutamate, thus decreasing
symptomology (Townsend, 2015).

6. Potential Interactions
• Namenda has very low potential interactions
according to Drugs.com. The minimal inhibition of
isoenzymes due to the metabolism by the
kidneys, lessens the potential for drug-drug
interactions.
• (Source: http://www.drugs.com/namenda.html).

7. Adverse Drug Reactions
• According to Drugs.com, the major specific drug
interaction for Namenda is to drugs that alkalize
urine. PH of urine > 7 reduces the tubular
clearance of Namenda by 80%, leading to
accumulation of Namenda in the system causing
adverse reactions.
• (Source: http://www.drugs.com/namenda.html).

8. Side Effects
• The side effects that are common with Namenda
are dizziness, confusion, headache, and
constipation (Source:
http://www.drugs.com/namenda.html).

9. Pharmacokinetics
• The mechanism of Pharmacokinetics allows Namenda to
be highly absorbed after oral administration. Which
causes the drug to reach peak levels within three hours.
The body’s absorption of Namenda is not effected by
food. Because it undergoes minimal metabolism,
approximately 70% is excreted unchanged in the urine
(Source: http://www.drugs.com/namenda.html).

10. Drug Binding Issues
• The major specific drug interaction for Namenda is to drugs that
alkalize urine. PH of urine > 7 reduces the tubular clearance of
Namenda by 80%, leading to accumulation of Namenda in the
system causing adverse reactions.
• The classification of potential adverse binding drugs and altered
plasma concentration is greatest with Carbonic Anhydrase
Inhibitors (e.g. Diamox, Daranide) and Sodium Bicarbonate (e.g.
Antacid). Furthermore, the plasma protein bindings of Namenda is
45% which decreases the risk of interactions with medication such
as Warfarin and Digoxin (Source:
http://www.drugs.com/namenda.html).

11. Improving Communication
• The greatest outcome seen is established when multidisciplinary
teams work together.
• Patients would benefit well if there was a database that could be
updated by the patient or a caregiver that would be a
comprehensive log of their medication. When prescribed new
medication, each pharmacist would have the ability to access that
log before dispensing medication in order to properly check for
duplications, interactions, and allergies. The patient’s overall
safety outcome would be improved substantially (Floroff, et. al).

12. Application to the Practice Setting
• The majority of my patients are Geriatrics with neurocognitive disorders
especially Alzheimer’s disease.
• Many patients have medication that is secreted by the kidneys and they
take many medications that affect urine PH. This knowledge will be
applied to my daily education on their medications and I will be
searching for use of antacids.
• Patient do not know or think that Tums or Rolaids are considered
medication.
• I have a better insight into what medication can decrease the clearance
of Namenda through the urine and which classification of medication
interacts with Namenda.

13. References
• Arcangelo, V. P., & Peterson, A. M., (2013). Pharmacotherapeutics for advanced
practice. A practical approach. (3rd ed.). Philadelphia, PA. Lippincott Williams and
Wilkins.
• Drugs.com [Internet] Namenda information from Drugs.com. C 2000-15 [updated:
2015 September 30: cited 2015 November 10]. Available from
http://www.drugs.com/monograph/namenda.html
• Floroff, C., Slattum, P., Harpe, S., Taylor, P., & Brophy, G. (n.d). Potentially
Inappropriate Medication Use is Associated with Clinical Outcomes in Critically Ill
Elderly Patients with Neurological Injury. Neurocritical Care, 21(3), 526-533.
• Vallerand, A. H., and Sanoski, C. A. (2014). Davis’s drug guide for nurses. (14th ed.).
Valley Stream, NY. F. A. Davis Company.