Adult Dose titration: Max daily dose: 20 mg. In order to reduce undesirable effects, maintenance dose is achieved by upward titration of 5 mg wkly over the first 3 wk as follows: Wk 1 (day 1-7): 5 mg daily; wk 2 (day 8-14): 10 mg daily; wk 3 (day 15-21): 15 mg daily; wk 4 & maintenance: 20 mg daily. Elderly >65 yr 20 mg daily. Moderate renal impairment (CrCl 30-49 mL/min) 10 mg daily, increased up to 20 mg daily if tolerated well after at least 7 days. Severe renal impairment (CrCl 5-29 mL/min) 10 mg daily.
Patients w/ epilepsy; recent MI, uncompensated CHF & uncontrolled HTN. Careful monitoring of patients w/ factors or condition that may elevate urine pH. Not recommended in patients w/ severe hepatic impairment. Minor to moderate influence on the ability to drive & use machines. Should not be used during pregnancy. Women taking memantine should not breast-feed. Childn & adolescents <18 yr.
Effects of L-dopa, dopaminergic agonists & anticholinergics may be enhanced. Effects of barbiturates & neuroleptics may be reduced. Consider possible drug interaction w/ antidepressants. Effects of antispasmodics eg, dantrolene or baclofen may be modified. Avoid concomitant use w/ amantadine, ketamine or dextromethorphan. Possible risk w/ phenytoin. Plasma levels of cimetidine, ranitidine, procainamide, quinidine, quinine & nicotine may be increased. Possible reduction of hydrochlorothiazide serum level. Increased INR w/ warfarin.
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