Tolerability of memantine monotherapy versus adding memantine as combination therapy
Estevana Isaac1, David Ney1, Mijail Serruya1
1Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States of America.
Journal of the National Medical Association
|March 11, 2022
Summary
Patients with neurodegenerative disorders experienced significantly more side effects with combination therapy (donepezil and memantine) than with memantine monotherapy. Switching to memantine monotherapy is recommended for patients with polypharmacy to improve tolerability.
Area of Science:
- Neuroscience
- Pharmacology
- Geriatrics
Background:
- Combination therapy with donepezil and memantine is common for neurodegenerative disorders.
- Adverse drug reactions (ADRs) from combination therapy can be severe in older adults with polypharmacy.
- This study investigates the tolerability of memantine monotherapy versus combination therapy.
Purpose of the Study:
- To compare the tolerability of memantine monotherapy versus combination therapy in patients with neurocognitive disorders.
- To identify factors influencing adverse drug reactions in patients undergoing these treatments.
- To provide evidence-based recommendations for optimizing pharmacotherapy in neurodegenerative diseases.
Main Methods:
- Retrospective chart review of 175 patients with neurocognitive disorders.
- Inclusion of side effects reported to a neurocognitive subspecialist.
- Data collected from 2016 to 2019.
Main Results:
- Patients on combination therapy had significantly higher odds of reporting side effects (OR=4.33, CI 95% (1.62, 11.52), p=0.003).
- Over 80% of patients reporting side effects had polypharmacy or excessive polypharmacy.
- Polypharmacy was a significant predictor of outcomes in patients on combination therapy (p=0.047).
Conclusions:
- Switching from cholinesterase inhibitor (CI) monotherapy to memantine monotherapy is recommended for patients with moderate-severe neurodegenerative disease and polypharmacy (>10 medications).
- This approach aims to increase medication tolerability and reduce adverse events.
- Further research with larger sample sizes is needed to explore other potential predictors of side effects.
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