Dosage
What is the recommended dosage for Axura®?
The proposed daily dose is 20 mg. In order to reduce the risk of side effects the maintenance dose is achieved by upward titration of 5 mg per week over the first 3 weeks as follows: 5 mg daily (half a tablet in the morning) during the 1st week, 10 mg per day in the 2nd week (half a tablet twice a day) and 15 mg per day in the 3rd week (one tablet in the morning and half a tablet in the afternoon). From the 4th week on, treatment can be continued with the recommended maintenance dose of 20 mg per day (one tablet twice a day).
Is it always necessary to titrate up to the full dose?
The recommended maintenance dose is 20 mg per day. It is, however, not always necessary to titrate up to the full dose if the desired effect can already be seen at a lower dose (e.g. 10 mg). But if Axura® is given at a lower than the recommended dose for other reasons, this may result in reduced efficacy.
Is it possible to use Axura® only once a day?
It is recommended to apply 20 mg in two doses: 10 mg in the morning and 10 mg in the afternoon.
Is it possible to increase the daily dose above 20 mg?
The maximum daily dose is 20 mg and should not be exceeded.
Dementia patients are older people, who often have impaired renal or hepatic function. Can I prescribe Axura® in these cases, and what dosage should be used?
In patients with normal to mildly impaired renal function (serum creatinine levels of up to 130 µmol/l) no dose reduction is needed. In patients with moderate renal impairment (creatinine clearance 40 - 60 ml/min/1.73 m2) the dose should be reduced to 10 mg per day. No data are available for patients with severely reduced kidney function, and thus memantine is not recommended to be used in these patients.
Dementia patients have been known to do the strangest things. What will happen if a patient takes a whole package of Axura® at once?
In one case of suicidal overdosage the patient survived the oral intake of up to 400 mg memantine with effects on the central nervous system (e.g. restlessness, psychosis, visual hallucinations, proconvulsiveness, somnolence, stupor and unconsciousness) which resolved without permanent sequelae. Treatment of overdosage should be symptomatic.
