A review comparing the safety and tolerability of memantine with the acetylcholinesterase inhibitors.
OBJECTIVE
Alzheimer's disease (AD) is prevalent among elderly people, who often have comorbid conditions, and may be prescribed multiple medications. Drug safety and tolerability is paramount in maximising efficacy and optimising patient and carer quality of life, as patients are vulnerable to adverse events (AEs) and/or compliance difficulties. The two principal categories of drug used in the treatment of AD are the acetylcholinesterase inhibitors (AChEIs) and the NMDA-receptor antagonist, memantine. This paper reviews the most recent safety data for memantine in comparison with the AChEIs.


METHODS
Review of most recent safety/tolerability data for memantine and AChEIs, derived from meta-analyses, pooled analyses, European SPCs and EMEA publications.


RESULTS
Memantine was found to have a favourable tolerability profile when used as monotherapy or in combination with other agents. AChEIs were found to be fairly well tolerated. All treatments commonly or very commonly produce dizziness and/or headache. AChEIs are associated with many more types of AEs than memantine, particularly in the gastrointestinal category. Agitation is a less common AE when comparing memantine treatment to placebo, but just as common when comparing AChEI treatment to placebo. Withdrawals in memantine-treated groups are comparable to placebo, and more common in AChEI-treated groups compared to placebo. Overall, drug-drug interactions, contraindications and warnings were fewer for memantine than AChEIs.


CONCLUSIONS
In both the clinical and naturalistic setting, memantine displays a safety and tolerability profile that is favourable and distinct from that of AChEIs. Safety and tolerability profiles should be given careful consideration when selecting treatment for AD patients.
Jones
R W
RW
RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK. r.w.jones@bath.ac.uk
D000368:Aged; D017109:Akathisia, Drug-Induced; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D004244:Dizziness / Q000453:epidemiology; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D018691:Excitatory Amino Acid Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D006261:Headache / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008559:Memantine / Q000009:adverse effects* / Q000627:therapeutic use
D002800:Cholinesterase Inhibitors; D018691:Excitatory Amino Acid Antagonists; D008559:Memantine