Hi Kathy,

We've talked about this issue on and off over the past year or so, so
you can read more at groups.google.com (search for "aricept
memantine").  In general, the acetylcholinesterase inhibitor (e.g.,
Aricept) is not stopped when memantine (Namenda) is added.

Here's one of my original posts on the subject (Donepizil = Aricept).

Darryl.

==========
By preventing the breakdown of acetylcholine, AChE inhibitors (e.g.,
Aricept) help treat the symptoms of AD (essentially until the loss of
acetylcholinergic neurons renders the drugs useless).  

It is thought that excessive activation or stimulation of NMDA
receptors, by glutamate or other agonists, may lead to the
degeneration of cholinergic cells.  Memantine *blocks* the NMDA
receptor thereby preventing this activation.

In theory, if memantine slows the destruction of acetylcholine
producing cells and an AChEIs prevents the breakdown of acetylcholine,
an improvement in a patient's symptoms may result.  

A recent paper in the Journal of the American Medical Association
sheds light on the combination therapy.  IMHO, the AChE inhibitor
should not be stopped under any circumstances, unless the disease has
progressed too far.  

In the article "Memantine Treatment in Patients With Moderate
to Severe AD Already Receiving Donepezil" all subjects had been on a
stable dose (6 months) of Aricept prior to starting memantine.  Again,
memantine should be *added* to the regimen; Aricept should NOT be
stopped.  

In the study, the dose of memantine was titrated in 5 mg weekly
increments up to 20 mg/day (5 mg twice daily).  The dose of Aricept
remained constant.

If your doctor is interested, the reference is:

JAMA, January 21, 2004; Vol. 291, No. 3

Your worries could be justified, it was a disaster for my dad who did
exactly that. It seems from reading here that the two work better in
conjunction with one another, quite a few seem to be on both.

Kathy, you don't need to stop the Aricept. You can just add the
Namenda. The two drugs act in diffent ways. Here is some info on the
topic and you can see, you most definately can take the two at once
with no particular problems.

http://alzonline.net/en/reading/mmi_namenda.php

Mary G.

Kathy-
My husband has been on Namenda since Feb of this year..Namenda was
added to the Aricept -- which was NOT stopped..
 
Of course, we will not be able to prove this helped slow the AD...but
feel (hope)  if these drugs keep him continent for a few months
longer---it's a small victory..

Florence

In Mom's case, she couldn't handle the Aricept. It caused her to get up
around 1:00 or 2:00 in the morning swearing it was 6:00 am and time to
get up. When we switched doctor's, he tried her on Reminyl which seemed
to help. They start you out at 4 mg and gradually get you up to 16 mg.
When we went to 8 mg, the same thing happened with her getting up early
in the morning. So we went back to 4 mg. When the doctor suggested
putting Mom on Namenda, I asked about taking her off the Reminyl.
Afterall she was only on 4 mg anyway. He said if we saw any improvement
at all to leave her on the Reminyl and add the Namenda as well. It has
seemed to work for some time now. The Namenda didn't have the same side
effects, and we were able to go to full strength on it. And the doctor
has helped us by providing samples.

 Hi, Kathy:
 I can't add much more than the others except to say the Aricept is usually
continues and the Namenda is added on.
 My husband has been on Aricept for several years. He started the Namenda
about two years before it was approved here in the US (In Europe, it;s
called Memantine, Axura, etc.). When it became available in the US, I
switched to the Namenda and stopped the Memantine. Big mistake. Although the
formularies were supposed to be exact, there was something......he started
failing fast. Anyway, I put him back on the Memantine. His neurologist and I
talked about it and decided to try titering down the Memantine while
titering up the Namenda. That worked great. This past May, we went to
Hawai'i. On returning, he was given the mini mental-state exam and scored
26!
 No, it hasn't stayed that way. There was a surgery that he had to have,
plus a very unfortunate conversation with his daughter.....he's seeing the
neurologist today. I'll be surprised if his MMSE is better than 15 right
now.
 Sorry. I got off the subject. Keep the Aricept going and add the Namenda.
It works better than just the Namenda.
 Mary K
 > Hi,
 >
 > I wonder if anyone out there has had experience with removing Aricept
 > from the patient's regimen and adding Namenda.  My mom has been on
 > Aricept for years now, and we are noticing some progression of her
 > dementia.  Her doctor has suggested Namenda, but we worry about losing
 > what capabilities she has now if we take her off the Aricept.  Also,
 > we've heard that once the Aricept is stopped that a patient doesn't
 > gain back what they've lost while off the med.
 >
 > Thank you in advance,
 > Kathy

Dear Kathy,

In my opinion namenda was a disaster for John.  This may have been
because he has EOAD which presents differently.  In any case, he seemed
to become more aware of how much this disease has changed him & became
very agitated---went off all medicines including aricept & heart.  I
wish we had never tried the namenda because he was much more content &
willing to accept the good days with the bad.

May be we were just unlucky---hope the combination works for you.

Always,

Char

My client is taking both Aricept and Namenda, after a period of time for
adjustment to the Namenda, she is now taking the Aricept in the morning
with the Namenda, and Namenda in the evening.

She is also taking Vitamin E and Cod Liver Oil supplements, drinks A LOT
of orange juice, and loves Frosted Mini Wheats cereal. :)

I have noticed over the period of time she has been adjusting to both,
that there are more frequent moments of clarity.

I don't have any idea if this will help or not. . .

Feather