Treatment should be initiated under the supervision of a physician experienced in the diagnosis and treatment of Alzheimer's dementia. Treatment should be started only in the presence of a person who will regularly monitor the patient's medication. The diagnosis must be in accordance with this instruction. Memantine is taken orally once at the same time. Food intake does not affect memantine intake. Adults: Dose selection The maximum daily dose is 20 mg / day. To reduce the risk of undesirable adverse reactions, the dose is selected by a single increase in the dose taken by 5 mg / day during the first 3 weeks in accordance with the following scheme: First week (1-7 days): Within a week, a dose of 5 mg / day is prescribed. Second week (8-14 days): Within a week, appoint a dose of 10 mg / day. Third week (15-21 days): Within a week, 15 mg / day is prescribed. From the fourth week: It is prescribed at a dose of 20 mg / day. The recommended maintenance dose of memantine is 20 mg / day. Elderly: Based on the results of clinical studies, the daily dose for patients over the age of 65 is set at 20 mg / day. Children: Memantine is not recommended for use by anyone under 18 years of age due to insufficient safety and efficacy data. Patients with renal insufficiency: With moderately impaired renal function (creatinine clearance (CC) 50 - 80 ml / min), a dose change is not required. With a moderate form of renal failure (CC 30 - 49 ml / min), the initial daily dose is 10 mg / day. If the drug is well tolerated for 7 days, the daily dose may be increased to 20 mg / day in accordance with the standard dose selection regimen. In severe renal failure (CC 5 - 29 ml / min), the daily dose is 10 mg / day. Patients with hepatic impairment: In mild to moderate forms of hepatic impairment (grades A and B), a dose change is not required. It is not recommended to take memantine in severe hepatic impairment due to the lack of data on its use.

Individual hypersensitivity to the drug, severe renal dysfunction, pregnancy, breastfeeding, children under 18 (due to insufficient data).

From the immune system. Often: hypersensitivity to the drug. Mental disorders. Often: drowsiness; rarely: confusion, hallucinations; frequency not established: psychotic reactions. Disturbances from the central and peripheral nervous system. Often: dizziness; rarely: gait disturbance; very rare: convulsions. Violations of the cardiovascular system. Often: shortness of breath. Violations of the cardiovascular system. Infrequently: heart failure; rarely: hypertension, venous thrombosis / thromboembolism. Respiratory system disorders. Often: shortness of breath. Gastrointestinal disorders. Often: constipation; rarely: nausea, vomiting; frequency not established: pancreatitis. On the part of the body as a whole - common side reactions. Often: headache; rarely: fatigue. Hallucinations were observed mainly in patients with Alzheimer's disease at the stage of severe dementia. There are separate reports of the occurrence of pancreatitis when using the drug in clinical practice (data obtained after the drug was released on the market).

With simultaneous use with levodopa drugs, dopamine receptor agonists, anticholinergics, the effects of the latter may increase. When used simultaneously with barbiturates, antipsychotics, the effect of the latter may decrease. When used together, it can change (increase or decrease) the effect of dantrolene or baclofen, so the doses of drugs should be selected individually. The simultaneous use of memantine with amantadine should be avoided due to the risk of pharmacotoxic psychosis. Both compounds are NMDA antagonists. Perhaps this applies to ketamine and dextromethorphan. Cimetidine, ranitidine, procainamide, quinidine, quinine and nicotine can also interact with memantine, leading to a potential risk of increased plasma levels of the drug. There is a possibility of reducing the level of hydrochlorothiazide (HCT) in serum when memantine is used together with HCT. After the release of memantine on the market, in isolated cases, an increase in the international normalized ratio (INR) was described in patients receiving concomitant warfarin treatment. However, no causal relationship has been established. It is advisable to monitor prothrombin time or INR in patients receiving concomitant treatment with oral anticoagulants. Memantine does not interact with cytochrome P450 isoenzymes. No interaction effects were recorded with glibenclamide, metformin and donepezil.

Symptoms: Relatively large overdoses (200 mg and 105 mg / day for 3 days) are manifested by symptoms of fatigue, weakness and / or diarrhea or no symptoms. Overdose up to 140 mg / day. or an unknown amount of the drug is expressed by symptoms associated with the central nervous system (confusion, drowsiness, dizziness, vertigo, anxiety, agitation, hallucinations and disturbed gait) and / or gastrointestinal disturbances (vomiting and diarrhea). In the most serious cases of overdose, the patient survived after taking more than 2000 mg of memantine with adverse events from the nervous system (coma for 10 days, later diplopia, agitation). The patient received symptomatic therapy and plasmapheresis and recovered without any consequences. Another reported case of serious overdose is 400 mg once. The patient recovered without consequences. A reaction from the nervous system was noted: anxiety, psychosis, visual hallucinations, stupor, seizures, drowsiness, unconsciousness. Treatment: symptomatic therapy, gastric lavage, intake of activated charcoal, acidification of urine, forced diuresis (if necessary). There is no specific antidote.