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Antipsychotic Dose-Sparing Effect with Addition of Memantine

Assistant Professor of Pharmacy Practice, Geriatrics, Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, 3601 4th St., Ste. 1C162, Mail Stop 8162, Lubbock, TX 79430-8162, fax 806/743-4209, rebecca.sleeper{at}ttuhsc.edu

Reprints: Dr. Sleeper

OBJECTIVE: To describe a case of an antipsychotic-sparing effect achieved after the addition of memantine to the regimen of a patient with severe Alzheimer's disease and aggressive behavioral disturbances.

CASE SUMMARY: A 78-year-old white man with severe Alzheimer's disease was receiving risperidone 2 mg 3 times daily for persistent aggressive and dangerous behavioral disturbances. Memantine was initiated, and the dose was titrated to 10 mg twice daily. The patient's response included improvement in functional status and resolution of problematic behaviors, allowing repeated reduction of the risperidone dose and ultimate discontinuation.

DISCUSSION: Antipsychotics are often employed to treat behavioral disturbances for patients with Alzheimer's disease; however, the adverse effect potential of these agents remains a significant concern. Adjunctive medications that maintain or improve behavioral symptoms yet allow an antipsychotic-sparing effect are attractive. Such experiences have previously been described with other drug classes, but clinical experience is evolving with memantine. For this patient, the effect of this agent on behavioral symptoms and risperidone requirements is one example of such an antipsychotic-sparing effect.

CONCLUSIONS: Response to memantine therapy may include behavioral improvements allowing a dose-sparing effect of antipsychotic medication. Changes in psychoactive drug burden may be a valuable surrogate marker of memantine's effects on behavior.

Key Words: Alzheimer's disease, antipsychotic, memantine

Published Online, August 2, 2005. www.theannals.com, DOI 10.1345/aph.1G207

This article has been cited by other articles:

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				P. Aupperle Management of aggression, agitation, and psychosis in dementia: Focus on atypical antipsychotics American Journal of Alzheimer's Disease and Other Dementias, March 1, 2006; 21(2): 101 - 108. [Abstract] [PDF]