Meman/donepz 14-10mg ER Capsules

Memantine is a voltage-dependent, moderate-affinity uncompetitive NMDA receptor antagonist. It binds to the NMDA receptor-operated cation channels, preventing the prolonged influx of Ca2+ ions, which can lead to neuronal dysfunction and death. Donepezil is a reversible inhibitor of acetylcholinesterase (AChE), the enzyme responsible for the hydrolysis of acetylcholine. By inhibiting AChE, donepezil increases the concentration of acetylcholine at cholinergic synapses in the central nervous system, thereby enhancing cholinergic function.

Serious Side Effects: Seek Medical Help Immediately

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you experience any of the following symptoms, contact your doctor or seek medical attention right away:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Urination difficulties
Severe dizziness or fainting
Fever, chills, or sore throat
New or worsening breathing difficulties
Seizures
Stomach pain or heartburn
Black, tarry, or bloody stools
Vomiting blood or coffee ground-like material
Slow heartbeat
Abnormal heartbeat
Bruising

Other Possible Side Effects

Like all medications, this drug can cause side effects. However, many people do not experience any side effects or only have mild ones. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor or seek medical attention:

Diarrhea
Upset stomach or vomiting
Decreased appetite
Dizziness or headache
Muscle cramps
Fatigue or weakness
* Sleep disturbances

Reporting Side Effects

This list is not exhaustive, and you may experience other side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
Potential interactions with other medications or health conditions. This medication may affect or be affected by other drugs or health problems, so it is crucial to disclose all relevant information.

To ensure safe treatment, provide your doctor and pharmacist with a comprehensive list of:

All prescription and over-the-counter (OTC) medications you are taking
Natural products and vitamins you are using
* Any health problems you have

Carefully review your medications and health conditions to confirm that it is safe to take this medication in conjunction with them. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.

It is essential to inform all of your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. This drug does not cure Alzheimer's disease, and you should continue to receive regular care from your doctor. If you are pregnant, planning to become pregnant, or are breastfeeding, be sure to discuss this with your doctor, as you will need to carefully weigh the potential benefits and risks of this medication to both you and your baby.

• Anticholinergics (e.g., atropine, scopolamine): Donepezil may antagonize their effects.
• Succinylcholine, other neuromuscular blocking agents: Donepezil may exaggerate neuromuscular blockade.
• Other acetylcholinesterase inhibitors (e.g., rivastigmine, galantamine): Increased risk of cholinergic adverse effects.
• NMDA receptor antagonists (e.g., amantadine, ketamine, dextromethorphan): Increased risk of CNS adverse reactions (memantine).

• Beta-blockers (especially those that slow heart rate, e.g., metoprolol, carvedilol): Increased risk of bradycardia and syncope with donepezil.
• Drugs that prolong the QT interval (e.g., quinidine, amiodarone, sotalol, certain antipsychotics): Donepezil may cause slight QT prolongation.
• CYP2D6 and CYP3A4 inhibitors (e.g., quinidine, fluoxetine, paroxetine, ketoconazole, erythromycin): May increase donepezil exposure.
• Urinary alkalinizers (e.g., carbonic anhydrase inhibitors, sodium bicarbonate): May decrease memantine excretion, leading to increased plasma levels.

• CYP2D6 and CYP3A4 inducers (e.g., rifampin, phenytoin, carbamazepine, phenobarbital): May decrease donepezil exposure.

• Nausea
• Vomiting
• Diarrhea
• Dizziness
• Headache
• Confusion
• Agitation
• Hallucinations
• Syncope
• Bradycardia
• Muscle cramps
• Fatigue
• Urinary incontinence

Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects at high doses.

It is not known if memantine or donepezil are excreted in human milk. Due to the potential for serious adverse reactions in breastfed infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Safety and effectiveness have not been established in pediatric patients. Not indicated for use in children.

Alzheimer's disease primarily affects the geriatric population. No specific dosage adjustments are typically needed beyond those for renal or hepatic impairment. Elderly patients may be more susceptible to adverse effects such as dizziness, falls, and bradycardia.

• Memantine/donepezil ER (Namzaric) is indicated for the treatment of moderate to severe Alzheimer's disease in patients already stabilized on donepezil 10 mg.
• The extended-release formulation allows for once-daily dosing, which may improve adherence compared to multiple daily doses of individual components.
• Titration of memantine is crucial to minimize adverse effects, especially dizziness and confusion. The combination product comes in various strengths to facilitate this.
• Monitor for cholinergic side effects (nausea, vomiting, diarrhea, bradycardia) from donepezil and CNS side effects (dizziness, confusion, hallucinations) from memantine.
• Caution should be exercised in patients with a history of cardiac conduction abnormalities, peptic ulcer disease, or asthma/COPD due to donepezil's effects.
• Renal function should be assessed before initiating and periodically during treatment with memantine/donepezil due to memantine's renal excretion.

• Donepezil (Aricept)
• Rivastigmine (Exelon)
• Galantamine (Razadyne)
• Memantine (Namenda)

If your symptoms or health problems persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others, and do not take medication prescribed for someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly; do not flush them down the toilet or pour them down the drain unless instructed to do so by a healthcare professional. If you are unsure about the correct disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Some medications may come with an additional patient information leaflet, which your pharmacist can provide. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it was taken to ensure prompt and effective treatment.