Effect of Renal Impairment on the Pharmacokinetics of Memantine

Moritoyo, Takashi; Hasunuma, Tomoko; Harada, Kazuhiro; Tateishi, Tomonori; Watanabe, Makoto M.; Kotegawa, Tsutomu; Nagai, Masahiro; Kumagai, Yoshito; Fujitani, Tomomichi; Okura, T.; Fukuoka, Tatsunari; Miyoshi, Katsuhiko; Matsuura, Bunzo; Furukawa, Shinya; Kobori, Tomoe; Moritoyo, Hiroyoko; Nishikawa, Noriko; Tsujii, Tomoaki; Iwaki, Hirotaka; Nakamura, Masahiko; Makino, Satoshi; Ohnuma, Kei; Kikuchi, Yuji; Hashimoto, Megumi; Takasu, Masaru; Hashizume, Yutaka; You, Koji; Matsumura, Tomoko; Tanaka, Yuji; Matsumoto, Nahoko; Nakamura, Junichi; Miura, Jun; Akizawa, Tadao; Kitazawa, Kozo; Shibata, Takanori; Kuroki, Aki; Honda, Hirokazu; Mukai, Masanori; Ohashi, Kyoichi; Morimoto, Takahiro; Imai, Hiromitsu; Okudaira, Takuya; Sato, Fuminori; Imanaga, Junko; Tanaka, Katsuhiro; Nomoto, Masahiro

doi:10.1254/jphs.12043fp

Cited by 15 publications

(4 citation statements)

References 12 publications

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“…Based on the predicted steady-state plasma concentrations with current dosing regimen of 10 mg twice daily, no dosage adjustments are required for patients with mild or moderate renal impairment. A target dose of 5 mg twice daily is recommended in those with severe renal impairment (28,29) . The data comparing 10 mg BID and 20mg QD of the IR formulation, support use of once daily IR dosing; IR is prescribed as QD in Europe (30) .…”

Section: Discussionmentioning

confidence: 99%

Resolution of Inappropriate Sexual Behavior in an Elderly Male with Intellectual Disability with Memantine: Case Report, and Review of the Literature

Hafeez¹

2021

Preprint

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BackgroundMemantine is a non-competitive N-methyl-d-aspartate receptor antagonist approved for the treatment of moderate to severe Alzheimer's disease (AD). However, given its involvement of glutamate pathways, monotherapy as well as combination with other medications has been found to be effective in a number of psychiatric conditions (1). Resolution of new onset inappropriate sexual behavior (ISB) with memantine in a 67 year old male with intellectual disability (ID) is presented.Case presentationA 67 year old, white male with ID with a full scale IQ of 68, was treated in psychiatry long term for intermittent agitation and anxiety. At age 65, he manifested ISB which was not controlled with non pharmacologic measures and various medications. ISB resolved when memantine was added to his concurrent psychotropics and gradually increased to 10 mg BID. There was a recurrence of ISB after two years which remitted when memantine was increased to 25 mg. Based on clinical follow ups and serial MOCAs over three years, it was determined that this patient did not have a major neurocognitve disorder.ConclusionISB and its treatment is an understudied subject in individuals with intellectual disability. Resolution of new onset ISB in a 67 year old male with intellectual disability and comorbid mood disorder, is a previously unreported therapeutic effect of memantine. His ISB resolved with the addition of memantine 20 mg daily after multiple failed trials of various classes of psychotropics. Two years later, reemergence of ISB subsided with memantine 25 mg which is a higher than the recommended dose of this medication. Additional studies would be helpful in determining the maximum dose of this medication given its therapeutic efficacy at 25 mg daily which was well tolerated with stable medical tests.

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Section: Discussionmentioning

confidence: 99%

Resolution of Inappropriate Sexual Behavior in an Elderly Male with Intellectual Disability with Memantine: Case Report, and Review of the Literature

Hafeez¹

2021

Preprint

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“…It is likely to be dialyzed ( 35 ). Pharmacokinetic studies show that mild, moderate, and severe kidney impairment results in 1.62-, 1.97-, and 2.33-times higher plasma concentration-time curves, respectively, which is why the dose must be adjusted ( 43 ). It is recommended to use a target dose of 10 mg daily, which is half of the recommended dose, when the creatinine clearance (CrCl) < 30 ml/min ( 44 ).…”

Section: Cognitive Impairmentmentioning

confidence: 99%

Polypharmacy and Mental Health Issues in the Senior Hemodialysis Patient

et al. 2022

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Hemodialysis (HD) is the most common method of chronic kidney failure (CKF) treatment, with 65% of European patients with CKF receiving HD in 2018. Regular two to three HD sessions weekly severely lower their quality of life, resulting in a higher incidence of depression and anxiety, which is present in one third to one half of these patients. Additionally, the age of patients receiving HD is increasing with better treatment and care, resulting in more cognitive impairment being uncovered. Lastly, patients with other mental health issues can also develop CKF during their life with need for kidney replacement therapy (KRT). All these conditions need to receive adequate care, which often means prescribing psychotropic medications. Importantly, many of these drugs are eliminated through the kidneys, which results in altered pharmacokinetics when patients receive KRT. This narrative review will focus on common issues and medications of CKF patients, their comorbidities, mental health issues, use of psychotropic medications and their altered pharmacokinetics when used in HD, polypharmacy, and drug interactions, as well as deprescribing algorithms developed for these patients.

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“…Overall, the most common AEs (1% – 10%) included constipation, dizziness, headache, hypertension, and somnolence [40]. Because oral clearance is lower and elimination half-life is longer in patients with severe renal impairment, dose reduction in these patients is recommended [61, 62].…”

Section: N-methyl-d-aspartate Receptor Antagonistmentioning

confidence: 99%

Present Algorithms and Future Treatments for Alzheimer’s Disease

Grossberg

Tong

Burke

et al. 2019

JAD

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An estimated 47 million people live with Alzheimer’s disease (AD) and other forms of dementia worldwide. Although no disease-modifying treatments are currently available for AD, earlier diagnosis and proper management of the disease could have considerable impact on patient and caregiver quality of life and functioning. Drugs currently approved for AD treat the cognitive, behavioral, and functional symptoms of the disease and consist of three cholinesterase inhibitors (ChEIs) and the N-methyl-D-aspartate receptor antagonist memantine. Treatment of patients with mild to moderate AD is generally initiated with a ChEI. Patients who show progression of symptoms while on ChEI monotherapy may be switched to another ChEI and/or memantine can be added to the treatment regimen. In recent years, putative disease-modifying therapies have emerged that aim to slow the progression of AD instead of only addressing its symptoms. However, many therapies have failed in clinical trials in patients with established AD, suggesting that, once developed, disease-modifying agents may need to be deployed earlier in the course of illness. The goal of this narrative literature review is to discuss present treatment algorithms and potential future therapies in AD.

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Effect of Renal Impairment on the Pharmacokinetics of Memantine

Cited by 15 publications

References 12 publications

Resolution of Inappropriate Sexual Behavior in an Elderly Male with Intellectual Disability with Memantine: Case Report, and Review of the Literature

Resolution of Inappropriate Sexual Behavior in an Elderly Male with Intellectual Disability with Memantine: Case Report, and Review of the Literature

Polypharmacy and Mental Health Issues in the Senior Hemodialysis Patient

Present Algorithms and Future Treatments for Alzheimer’s Disease

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