Transcript Memantine (Ebixor) - Core Care Standards

Memantine (Ebixor)
Joanne Lily Wombwell
Senior Memory Clinic Nurse
Hartington Unit, CNDRH
How it works
• Memantine in Alzheimer's, however, appears to work by protecting the
brain’s nerve cells against glutamate, which is a chemical released in
excess by cells damaged by Alzheimer’s or other neurological disorders.
• Glutamate plays an essential role in learning and memory by triggering
NMDA receptors to allow a controlled amount of calcium to flow into the
nerve cells. Too much glutamate, however, over stimulates the receptors,
leading to the neuronal cell death that is common to all degenerative
diseases.
• Glutamate binds to receptors in the brain, allowing calcium to flow freely
into the cell, a process known as ‘overexcitation.’ Chronic overexposure to
calcium in turn leads to cell degeneration. Memantine is believed to work
by preventing this destructive process by blocking the action of glutamate
at NMDA receptor sites.
INDICATIONS
• Moderatly severe AD (MMSE 13/30 and
under) with behavioural problems
• Cardiac complications preventing AcHI trial
• Unable to tolerate AcHI and moderatly
impaired
Side Effects
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Raised blood pressure
Dizzy spells
Constipation
Headache
Fatigue
Drowsiness
Vomiting
Increased confusion
Efficacy
• A pooled analysis of efficacy trials of the
NMDA antagonist Memantine indicates that it
is superior to placebo for treating and
preventing behavioural symptoms in
Alzheimer’s disease patients; however, the
therapeutic benefit appears to be modest.
Cost
Memantine titration pack
£43.13 for initial 28 days supply
Maintenance dose
£69.01 for 28 days supply
Case Study (MRS T)
• Female aged 69 (Mrs T)
• In Dementia care NH
• Donepezil stopped 8wk ago as outside NICE
guidelines, MMSE 8/30, aggressive
• Challenging behaviours
• Care home not coping
• Visited and prescribed Memantine titration pack
• Discussed with Consultant and made aware of
situation
• Referred to CMHT OA for care home advice
Review 2
• Review 2, 8 weeks on Memantine, MMSE not
done
• Less agitation
• Fewer incident reports
• Advised to continue behaviour monitoring
chart
• Seen by CPN and advice given to staff on
coping and managing behaviours
Review 3
• 12 weeks on Memantine
• MMSE 13/30
• Slightly calmer but remains paranoid and has
aggressive outbursts. Continue behaviour chart
• Covert administration of medication care plan
implemented with daughters consent
• Continue Memantine
• Review in 6 months
• Consultant to visit to review and has recently started
quetiapine
• Remains under care of CMHT OA
References
• http://www.primarypsychiatry.com/aspx/articl
edetail.aspx?articleid=1596
• www.lundbeck.co.uk
• BNF 60