A fixed-dose combination of memantine extended-release and donepezil in the treatment of moderate-to-severe Alzheimer's disease

• Published in: Drug design, development and therapy Vol. 10; pp. 3267 - 3279
• Main Authors: Deardorff, William James, Grossberg, George T
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2016; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Activities of daily living; Adolescent; Adult; Alzheimer Disease - drug therapy; Alzheimer Disease - psychology; Alzheimer's disease; Bioavailability; Biological Availability; Body weight loss; Caregivers; Cholinesterase; cholinesterase inhibitor; Cholinesterase inhibitors; Cholinesterase Inhibitors - administration & dosage; Cholinesterase Inhibitors - pharmacokinetics; Cognition; Cognition & reasoning; Combination drug therapy; Cost control; Delayed-Action Preparations - administration & dosage; Delayed-Action Preparations - pharmacokinetics; Dementia; Domains; Donepezil; Drug administration; Drug dosages; Drug therapy; Drug Therapy, Combination; Dysphagia; Enzymes; FDA approval; Female; fixed dose combination; Food; Glutamic acid receptors; Humans; Indans - administration & dosage; Indans - economics; Indans - pharmacokinetics; Male; Medical treatment; Memantine; Memantine - administration & dosage; Memantine - economics; Memantine - pharmacokinetics; Methods; Middle Aged; N-Methyl-D-aspartic acid receptors; Neurology; Nootropic Agents - administration & dosage; Nootropic Agents - pharmacokinetics; Nursing homes; Patient outcomes; Patients; Piperidines - administration & dosage; Piperidines - economics; Piperidines - pharmacokinetics; Proteins; Review; Severity of Illness Index; Statistical analysis; Syncope; Urine; Vomiting; Weight loss; Young Adult; United States > US; donepezil; Alzheimer’s disease; memantine; fixed-dose combination; cholinesterase inhibitor
• ISSN: 1177-8881; 1177-8881
• DOI: 10.2147/DDDT.S86463

Currently available therapies for the treatment of Alzheimer's disease (AD) consist of cholinesterase inhibitors (ChEIs), such as donepezil, and the
-methyl-D-aspartate receptor antagonist memantine. In December 2014, the US Food and Drug Administration approved Namzaric™, a once-daily, fixed-dose combination (FDC) of memantine extended-release (ER) and donepezil for patients with moderate-to-severe AD. The FDC capsule is bioequivalent to the coadministered individual drugs, and its bioavailability is similar when taken fasting, with food, or sprinkled onto applesauce. The combination of memantine and ChEIs in moderate-to-severe AD provides additional benefits to ChEI monotherapy across multiple domains and may delay the time to nursing home admission. A dedicated study of memantine ER compared to placebo in patients on a stable dose of a ChEI found statistically significant benefits on cognition and global status but not functioning. Treatment with memantine ER and donepezil is generally well tolerated, although higher doses of ChEIs are associated with more serious adverse events such as vomiting, syncope, and weight loss. Potential advantages of the FDC include a simpler treatment regimen, reduction in pill burden, and the ability to sprinkle the capsule onto soft foods. Patients who may benefit from the FDC include those with significant dysphagia, a history of poor compliance, or limited caregiver interaction. However, available evidence that these advantages would increase treatment adherence and persistence is conflicting, meaning that the added cost of switching patients from generic options to an FDC may not always be justified.