Namzaric is an approved, extended-release, fixed-dose combination of two oral drugs indicated for the treatment of moderate-to-severe Alzheimer’s disease. The two drugs that make up Namzaric are memantine hydrochloride and donepezil hydrochloride.
Memantine is an NMDA receptor (N-methyl-D-aspartate receptor) antagonist used to reduce the action of chemicals in the brain that may contribute to the symptoms of Alzheimer’s disease.
Donepezil is an acetylcholinesterase inhibitor that improves the function of nerve cells in the brain by preventing the breakdown of a chemical messenger called acetylcholine, which is important for memory, thinking, and reasoning. Donepezil is used to treat dementia in patients with Alzheimer’s disease.
Namzaric is indicated in patients who already are taking 10 mg of donepezil hydrochloride once daily and has shown greater improvement in cognition and overall function as compared to an acetylcholinesterase inhibitor alone. However, it is not known whether Namzaric prevents or slows the underlying disease process.
Dosage and administration
The recommended starting dose of Namzaric for patients on 10 mg of donepezil hydrochloride is 7 mg/10mg (memantine hydrochloride/donepezil hydrochloride), taken once daily in the evening. The dose should be increased in 7 mg increments to the recommended maintenance dose of 28 mg/10 mg. The minimum recommended interval between dose increases is one week.
Patients on memantine hydrochloride (10 mg twice daily or 28 mg extended-release once daily) and donepezil hydrochloride 10 mg once daily, can be switched to Namzaric 28 mg/10 mg, taken once daily in the evening.
Namzaric can be taken with or without food, whole, or sprinkled on applesauce.
In patients with severe kidney problems, the recommended maintenance dose is 14 mg/10 mg once daily in the evening.
Namzaric is contraindicated in patients with known hypersensitivity to memantine hydrochloride, donepezil hydrochloride, piperidine derivatives, or to any ingredients used in the formulation.
Warnings and precautions
Namzaric is likely to exaggerate muscle relaxation during anesthesia. It may cause slow heartbeat or heart block, particularly in patients with heart problems. The combination drug also may cause increased acid secretion in the stomach, which may result in gastrointestinal bleeding if the patient is at an increased risk of developing ulcers. Namzaric can cause diarrhea, nausea, and vomiting, difficulty passing urine, and seizures. Conditions that raise urine pH may decrease the urinary elimination of memantine, resulting in increased plasma levels of memantine. Namzaric may worsen lung problems in people with asthma or other lung diseases.
The most common side effects of memantine hydrochloride include headache, diarrhea, and dizziness. The most common side effects of donepezil hydrochloride include diarrhea, anorexia, vomiting, nausea, and bruising.
Namzaric should be used with caution if the patient is already taking NMDA antagonists. Namzaric may interfere with anticholinergic medications. Other drugs, including prescription and over-the-counter medicines, vitamins, and herbal products, may interact with donepezil and memantine.
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