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Namenda (Memantine): A cure for Alzheimer’s Disease?




Namemda- An Introduction to one of the newest Alzheimer’s medications.

Namenda (Memantine) was approved by the FDA in October as the newest treatment option for sufferers of Alzheimer’s disease. Memantine is marketed in the United States by Forest Laboratories and will be sold under the brand name of the Namenda, for patients with moderate to severe Alzheimer’s Disease. Forest Laboratories has stated that Namenda should be on the pharmacy shelves in January, 2004. Namenda has been sold for quite some time in Germany and Canada, and many U.S. families have been purchasing it over the internet for awhile. It is estimated that approximately 4 million Americans have Alzheimer’s disease, and about one million of them are believed to suffer severe symptoms. This will be the first time in which a medication is being offered for patients in the moderate to severe stage of the disease.

How will Namenda help?

Namenda has been found to help improve the memories and thinking skills of some patients who have moderate to severe impairments in their cognition (ability to think). However for the vast majority, the drug has been found to slow the pace of deterioration, allowing some patients to maintain their abilities to function somewhat independently for a longer period of time, which may benefit the patient and caregivers in some very important ways.




How is Namenda different from other Alzheimer’s medications?

While there are a few similarities between Namenda and other Alzheimer’s medications currently on the market, there are many more differences. Namenda is similar in that like the other Alzheimer’s medications (Aricept, Exelon, Reminyl and Cognex) it does not usually improve functioning as much as it retards the deterioration, allowing individuals to maintain independent functioning for a longer period of time. The most prominent difference is that these other medications are known to only be effective in the early stages of the disease, while Namenda is the first to have demonstrated effectiveness in the moderate to severe stages of Alzheimer’s. These other drugs delay the breakdown of another brain chemical called acetylcholine, which is necessary in the communication between nerve cells. Namenda naturally blocks excess amounts of another brain chemical called glutamate, which has been found to damage or kill nerve cells. Ultimately, doctors may eventually be able to prescribe combinations of medications in the hopes of better results.

Why should we feel hopeful about Namenda?

As just mentioned, doctor’s may be able to possibly use Aricept, Exelon, Reminyl or Cognex in the early stage the disease and possibly transition to a medication such as Namenda as the disease progresses to a more severe level of disability. It is recommended by the FDA’s scientific advisors whom have evaluated the drug, to recognize that Namenda does not offer miraculous benefits, and should not be a source of false hope to families of the most severely ill patients with Alzheimer’s. However, it is just another step in the progression of the development of medications which forestall the progressive deterioration of memory, and eventually may be an avenue toward a cure.

Namenda Side Effects: Special Warnings

What Namenda side effects may occur?

Although Namenda side effects cannot be anticipated, if any develop or change in intensity you need to contact your doctor immediately. Only your doctor can determine if it is still safe to continue taking this memory drug in spite of the Namenda side effects.

The Namenda side effects may include:

Confusion, constipation, coughing, dizziness, hallucinations, headache, high blood pressure, pain, sleepiness, vomiting

Namenda side effects and special warnings:

Namenda is not recommended for patients who have severe kidney impairment. There are various disease conditions that may alter the alkaline balance of the urine, which then may cause a build up of this medication in your body. You should always tell your physician about any major dietary changes, kidney problems such as renal acidosis, or urinary tract infections.

You should always make sure your doctor has information about any history of seizures that you may have. In addition to the previously mentioned Namenda side effects, this medication has not been formally studied among people with seizure disorders.

Namenda side effects and food and drug interactions:

In addition to the Namenda side effects, this medication should not be taken with certain other drugs as the effects can either be increased, decreased or altered in some other way. It is always important to check with your physician when combining Namenda with any of the following medications:

Amantadine (Symmetrel)
Cimetidine (Tagamet, Tagamet HB)
Cough suppressants that contain dextromethorphan (usually denoted as “DM”)
Glaucoma drug such as Diamox and Neptazane
Hydrochlorothiazide (HydroDIURIL)
Ketamine (Ketalar)
Nicotine (Nicoderm patch, Nicorette gum)
Quinidine (Quinidex)
Ranitidine (Zantac)
Sodium bicarbonate (baking soda, Alka-Seltzer)
Triamterene (Dyrenium DM)
You always need to be very sensitive to the combination of medications in addition to an awareness of any Namenda side effects.

Namenda Dosage: What is the recommended amount?


Namenda dosage for adults:

The recommended Namenda dosage is 10 mg twice a day. The Namenda dosage at the initiation of therapy is usually recommended to be 5 mg once a day for seven days, and then gradually increased by 5 mg every seven days up to a maximum Namenda dosage of 20 mg.

If side effects occur, your doctor may want to wait for about a week to increase the dose. Also, people who have impaired kidney function may also require lower doses.

Namenda dosage: How do you take this memory drug?

Namenda should be taken exactly as prescribed by your physician. The usual Namenda dosage is increased gradually in one-week intervals. Most physicians wait at least one week before increasing the dose. Dosages above the recommended amount have no additional benefit. This medication may be taken with or without food.

If you miss your dose…
You should take your forgotten dosage as soon as you remember, however, if it is almost time for your next dose, you should skip the missed one and continue on your regular schedule. You should never take two doses of Namenda at the same time.

Storage instructions…

You should always store this medication at room temperature.

Namenda Overdosage:

If your Namenda dosage is taken in excess of the recommended amount it may have serious consequences. If you suspect that you have taken too much, you should seek emergency treatment immediately.

Symptoms of Namenda overdosage may include…

Hallucinations, loss of consciousness, psychosis, restlessness, sleepiness, stupor

Taking the correct Namenda dosage is absolutely essential for the effective treatment of Alzheimer’s disease.

By Paul Susic Ph.D. Licensed Psychologist




Aricept Medication: Is this really a memory drug?




Brand name: Aricept

Generic name: Donepezil hydrochloride

Aricept medication: Why is this drug prescribed?

Aricept medication is one of only two drugs that have been found to provide some relief from symptoms of early Alzheimer’s disease. Aricept medication does not stop the progress of the underlying disease but may improve brain function in some sufferers of early Alzheimer’s disease. Alzheimer’s disease causes physical changes in the brain that interfere with the flow of information and disrupts memory, thinking and results in behavioral changes. These changes seem to be temporarily improved with the use of Aricept medication.

Aricept medication: Important information to know

In order to gain the benefits and maintain any improvement, Aricept must be taken on a regular basis. If it is stopped or taken irregularly, its benefits may be reduced or lost. You must also have some patience when starting this medication as it may take up to three weeks for any positive effects.

When should the Aricept medication not be prescribed?

Most geriatric doctors believe that there are least two main reasons to avoid Aricept: if you have an allergic reaction to the medication, or an allergic reaction to the group of antihistamines that includes Claritin, Allegra, Atarax, Periactin, Optimine, Nolahist and Hismanal.

Aricept medication: What if you’re pregnant or breast-feeding?




Since Aricept medication has not been prescribed for women of childbearing age it has not been tested among women who are pregnant or breast-feeding. Also, it has not been studied whether Aricept medication appears in breast milk and is therefore a threat to a feeding infant.

Aricept Side Effects and Special Warnings


What are some of the Aricept side effects that I may expect?

While specific Aricept side effects should not really be anticipated, if any develop or increase in intensity you need to contact your physician immediately. Only your doctor can determine if it is safe to continue this Alzheimer’s medication in spite of your or your loved one’s Aricept side effects.

Aricept side effects are usually more likely in higher doses and include diarrhea, fatigue, insomnia, loss of appetite, muscle cramps, nausea and vomiting. These are some of the more common side effects of this medication. When these side effects occur they are usually relatively mild and frequently get better as your treatment continues.

Other Aricept side effects may include:

Abnormal dreams, arthritis, bruising, depression, dizziness, fainting, frequent urination, headache, pain, sleepiness, weight-loss

Aricept side effects and special warnings:

This medication can increase the risk of seizures and aggravate asthma and other problems that you may have with your breathing. It can also cause fainting in people with heart conditions and may possibly slow your heartbeat. Obviously, you should always contact your physician if any of these problems occur. For individuals who take nonsteroidal anti-inflammatory drugs such as Aleve, Advil, or Nuprin, or for individuals who have had stomach ulcers, Aricept can possibly make your stomach side effects worse. You should always be cautious when taking this or any drug, and report all Aricept side effects to your doctor.

Aricept side effects and food and drug interactions:

In addition to the Aricept side effects, this medication may increase the effects of certain anesthetics. You should always make sure your doctor is aware that an individual is on Aricept prior to any surgeries. Aricept may also increase, decrease or otherwise alter the effects of other drugs. It is especially important to check with your doctor when taking Aricept with any of the following medications:

• Antispasmodic drugs such as Bentyl, Cogentin, and Pro-Banthine
• Bethanechol chloride (Urecholine)
• Carbamazepine (Tegretol)
• Dexamethasone (Decadron)
• Ketoconazole (Nizoral)
• Phenobarbital
• Phenytoin (Dilantin)
• Quinidine (Quinidex)
• Rifampin (Rifadin, Rifamate)

Although the above list of special precautions is fairly comprehensive, it does not include every possible Aricept side effect. You should always contact your physician if you experience any problematic concerns or any other medication related side effect that appears to be out of the ordinary.

Aricept dosages: How much is too much?

Aricept dosages: How is this medication taken?

Your Aricept dosage should be taken once a day, just before bedtime. It is very important to understand however, that your Aricept dosage must be taken every day. If Aricept is not taking regularly it will not work. This memory drug can be taken either with or without food.

If you miss your Aricept dosage…

You should take it as soon as you remember. However, if it is relatively close to the time for your next dose, you should skip the one that you missed and get back to your regular dosage schedule. You should never double your dose. Aricept should always be stored at room temperature.

Recommended Aricept dosage:

Adults

The usual starting Aricept dosage is 5 mg. once a day at bedtime, for a period of at least four to six weeks. You should not increase your dosage through this period of time unless you’ve been directed to do so by your physician. If it is warranted, your doctor may increase your Aricept dosage to as high as 10 mg.

Children

Aricept has not been tested among children for either safety or effectiveness.

Aricept overdosage:

Any medication taken in excess of the recommended amount can be dangerous to your health. If you suspect an overdosage of Aricept you need to contact your doctor immediately or seek medical attention.

Symptoms of Aricept overdosage include:

Collapse, convulsions, extreme muscle weakness (possibly ending in death), low blood pressure, nausea, salivation, slowed heart rate, sweating, vomiting

Taking your Aricept dosage as prescribed is incredibly important. The only way to receive the benefits of this effective Alzheimer’s medication is consistently and accurately taking your Aricept dosage.

By Paul Susic Ph.D. Licensed Psychologist



Alzheimer’s Medications and Vitamin E





Alzheimer’s Medication and treatment overview:

Currently there is no Alzheimer’s medications or treatment that can prevent or halt the mental decline associated with Alzheimer’s disease. Many drugs have been tested, but most have been abandoned, or found to be ineffective or even toxic in their use as an Alzheimer’s treatment. Most of the more effective Alzheimer’s medications have focused on preventing the destruction of neurons, with the ultimate goal of preventing the decline of memory functioning for as long as possible.




One theory that drives research in the area of Alzheimer’s treatment involves the belief that memory deficits in Alzheimer’s disease are in part a deficiency in the neurotransmitter acetylcholine. Medical scientists have continued to try to boost the amount of acetylcholine in the brain by administering substances containing it, and by stimulating the brain to manufacture it in increasing amounts, or by preventing the breakdown of the limited quantities of acetylcholine that the brain is able to make on its own. Lecithin and Choline, which are substances that appear naturally in many foods, are used by the body to produce acetylcholine. Both Lecithin and Choline have been given in supplement form to Alzheimer’s patients in the hope of improving their mental functioning, but have had very disappointing results at the present time.


Alzheimer’s Medication – Cholinesterase Inhibitors:

Some of the more recently reported Alzheimer’s mediations include the cholinesterase inhibitors, which were the first drugs approved by the U.S. Food and Drug Administration (FDA). These medications include tacrine (Cognex), donezepil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) and most recently memantine (Namenda) which slow the breakdown of acetylcholine. While they may reduce some the mild symptoms associated with Alzheimer’s disease, they do not prevent or in any way halt its progression. They merely delay the progression of the disease. According to guidelines published by the American Academy of Neurology in 2001, these medications are consistently better than placebo, but the average benefit is relatively small and the disease continues to progress despite the treatments.

Alzheimer’s treatment and Vitamin E:

The New England Journal of Medicine published an article in 1997 related to the study of the antioxidant properties of vitamin E. It was found in that research that patients with moderately severe Alzheimer’s disease received a daily dose of 2000 IU of vitamin E, 10 mg a day of selegeline, (a medication used for Parkinson’s disease treatment), both, or a placebo. Vitamin E or selegeline seem to slow the time to institutionalization and increase survival by approximately 7 months. The number of individuals losing their ability to do daily activities such as bathing or handling money was cut by one quarter. Combining vitamin E with selegeline did not improve the results.

The American Academy of Neurology concluded that based upon the study that there is good evidence to support the use of vitamin E in an attempt to slow the progression of the Alzheimer’s disease process. The evidence for selegiline to do the same was found to be weaker and there is no real advantage to using selegiline if vitamin E is already being used in an individual’s Alzheimer’s treatment.

An important fact to note in the use of vitamin E as an Alzheimer’s treatment is that while it is generally safe, large doses have been associated with bleeding in some individuals.

A Final Comment on the use of Alzheimer’s Medications.

While Alzheimer’s medication and treatment have limited effectiveness, they may delay the progression for some time and provide you some additional time to spend with your love ones before the inevitable decline in activites of daily living.

By Paul Susic Ph.D.. Licensed Psychologist (Geriatric Psychologist)




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