Memantine ER/Donepezil

Combined cholinesterase inhibitor + NMDA antagonist

Memantine ER / Donepezil

Namzaric

Namzaric is a once-daily fixed-dose combination of memantine ER and donepezil, for patients with moderate-to-severe Alzheimer's already stable on both components. The convenience is real, daily pill burden cut roughly in half. The trade-off is reduced ability to titrate each component independently.

Experience

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Problems

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Titration strategies

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Effects

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Pharmacokinetics

Absorption

Both ~100% absorbed.

Distribution

Memantine ~45% protein bound; donepezil ~96%.

Metabolism

Memantine: minimal hepatic. Donepezil: CYP2D6, CYP3A4.

Elimination

Memantine: renal (mostly unchanged). Donepezil: renal and hepatic.

Interactions

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Monitoring

Cognitive function (MMSE/MoCA); GI tolerability; heart rate (donepezil bradycardia risk); renal function (memantine adjustment).

Patient counseling

Take in the evening. Capsule may be opened and sprinkled on applesauce. Do not start this combo in patients not already stable on both components.

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See also

Memantine, Donepezil, Galantamine, Rivastigmine

References

Summary

Classes

Combined cholinesterase inhibitor + NMDA antagonist

Pharmacy

Starting dose

For patients already stable on memantine 28 mg/d + donepezil 10 mg/d, switch to one capsule daily of equivalent strength

Preparations

7/10, 14/10, 21/10, 28/10 mg ER capsules (memantine ER / donepezil)

US FDA Max

28/10 mg/d

Pharmacology

Routes

Oral (capsule whole or opened/sprinkled on applesauce)

Onset

Component effects accumulate over weeks

Duration

24 h

Half-life

~60–80 h (memantine); ~70 h (donepezil)

Bioavailability

~100% both components

Pregnancy

Not relevant (geriatric problem)

Legal status

Rx-only in US

Purported mechanism

Donepezil: reversible AChE inhibitor, increases synaptic acetylcholine. Memantine: uncompetitive low-affinity NMDA receptor antagonist, dampens pathological glutamate overactivation while preserving normal synaptic signaling. Targets two distinct mechanisms in Alzheimer's.