title: Safety and tolerability of once-daily versus twice-daily memantine: a randomised, double-blind study in moderate to severe Alzheimer's disease.
abstract: OBJECTIVE
  To assess the safety and tolerability of three different dosing schedules of memantine in patients with moderate to severe Alzheimer's disease (AD).
  
  
  METHODS
  This 12-week, randomised, double-blind study, investigated three dosing schedules of memantine: OD1 (20 mg once daily with a 1-step up-titration); OD3 (20 mg once daily with a 3-step up-titration); and BID3 (10 mg twice daily with a 3-step up-titration as currently recommended in the memantine labelling). The study comprised 78 patients with moderate to severe AD (DSM-IV-TR criteria; MMSE score < or = 18), 70% of whom were on stable dosing of acetylcholinesterase inhibitor (AChEI) initiated > or = 3 months prior to study start. Safety and tolerability were assessed by the number of withdrawals, adverse events (AEs) and monitoring of vital signs.
  
  
  RESULTS
  The number of patient withdrawals was low: 3 of 27 in OD1, 1 of 25 in OD3 and 2 of 26 in BID3. One or more AEs were reported in 9 patients in OD1, 7 patients in OD3 and 12 patients in BID3. Most AEs were mild or moderate, and typical for the population studied; no clinically important differences in AEs or vital signs were observed between the different dosing schedules. There were no between-group differences in efficacy, as assessed by clinical global severity and clinical global change. These results are consistent with the good safety profile of memantine observed in larger studies.
  
  
  CONCLUSIONS
  Although relatively small in size, the study indicates that once-daily dosing and twice-daily dosing of memantine are similar in terms of safety and tolerability.
authors.affiliation: Research Institute for the Care of the Elderly (RICE), Bath, UK. R.W.Jones@bath.ac.uk
authors.forename: Roy W
authors.initials: RW
authors.lastname: Jones
authors.forename: Antony
authors.initials: A
authors.lastname: Bayer
authors.forename: Fraser
authors.initials: F
authors.lastname: Inglis
authors.forename: Andrew
authors.initials: A
authors.lastname: Barker
authors.forename: Ravinder
authors.initials: R
authors.lastname: Phul
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D001007:Anxiety / Q000139:chemically induced; D015259:Dopamine Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008559:Memantine / Q000008:administration & dosage* / Q000009:adverse effects; D001523:Mental Disorders / Q000139:chemically induced; D009483:Neuropsychological Tests; D018579:Patient Selection; D012449:Safety; D016896:Treatment Outcome
chemical_list: D015259:Dopamine Agents; D008559:Memantine