title: Influence of urine pH and urinary flow on the renal excretion of memantine.
abstract: OBJECTIVE
  The present study assessed the influence of urinary flow rate and urine pH on the renal excretion of the NMDA-receptor antagonist memantine.
  
  
  METHODS
  In a randomized, open, four-period cross-over trial, 12 healthy male volunteers received 10 mg memantine daily for 43 days. After reaching steady state conditions the volunteers were allocated to four different regimens to alter urine pH and urinary flow, which were each separated by a 1 week period while the study medication continued (A: acidification of urine pH, low urinary flow; B: acidification of urine pH, high urinary flow; C: alkalinization of urine pH, low urinary flow; D: alkalinization of urine pH, high urinary flow).
  
  
  RESULTS
  The renal clearance of memantine (CL(R)) in regimen A and B was 7-10 fold higher in comparison with regimen C and D (P<0.05). There were small but statistically significant differences of CL(R) between the two regimens with acidic urine pH (A: median: 210.2 ml min(-1) vs B: median: 218.7 ml min(-1)) and between the two regimens with alkaline urine pH (C: median: 19.4 ml min(-1) vs D: median: 30.5 ml min(-1)). The amount of memantine excreted into the urine within one regimen (Ae0-24h) was 5.7-7.4 fold higher in regimens A and B than C and D (P< 0.05). Differences of the AUC(0,24 h) and Cmax/AUC(0,24 h) were significant (P<0.05) between each of the regimens with acidic urine pH (A, B) and regimens (C, D) with alkaline urine pH (A vs C, A vs D, B vs C, B vs D) but not between regimens A vs B or C vs D.
  
  
  CONCLUSIONS
  The present study demonstrated a considerable effect of urine pH, whereas no clinically relevant change of the renal excretion of memantine with urinary flow could be detected. As the renal excretion of memantine may have an impact on therapeutic efficacy changes of dietary habits that may alter urine pH should be avoided during treatment with memantine.
authors.affiliation: Department of Clinical Pharmacology, Georg-August-Universität Göttingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Freudenthaler
authors.forename: I
authors.initials: I
authors.lastname: Meineke
authors.forename: K H
authors.initials: KH
authors.lastname: Schreeb
authors.forename: E
authors.initials: E
authors.lastname: Boakye
authors.forename: U
authors.initials: U
authors.lastname: Gundert-Remy
authors.forename: C H
authors.initials: CH
authors.lastname: Gleiter
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000652:urine; D018592:Cross-Over Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008559:Memantine / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000652:urine; D008657:Metabolic Clearance Rate
chemical_list: D000928:Antidepressive Agents; D008559:Memantine