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Ebixa (Memantine)

How does it work?

Ebixa tablets and oral drops contain the active ingredient memantine hydrochloride, which is a type of medicine called an NMDA-receptor antagonist. It is used for treating Alzheimer’s disease.

There is increasing evidence that memory loss and dementia in Alzheimer's disease are related to malfunctioning of the signals that pass messages between the nerve cells in the brain. In particular, there is evidence that excessive activity of a natural body chemical called glutamate contributes to the symptoms of Alzheimer’s and the progression of this disease.

Glutamate acts on receptors called NMDA receptors that are found on nerve cells in the brain. These receptors and nerve cells are involved in transmitting nerve messages in the brain that are important in learning and memory. Glutamate can damage the nerve cells by excessively stimulating the NMDA receptors.

Memantine works by blocking the NMDA receptors in the brain. This blocks the excessive activity of glutamate, but still allows the normal activation of these receptors that occurs when the brain forms a memory.

Memantine may therefore improve brain functioning in Alzheimer's disease, and may also block the glutamate activity that could cause further damage to the brain cells.

Memantine is licensed to treat moderate to severe Alzheimer's disease. Studies have demonstrated that memantine causes a small improvement or stabilisation in the cognitive functioning (thinking, learning and memory) and daily functioning of this group of patients.

What is it used for?

  • Moderate to severe Alzheimer's disease.

Warning!

  • A doctor will only prescribe this medicine if the patient has a caregiver available who will regularly make sure that the patient is taking the medicine.
  • Moderate to severe Alzheimer's disease will usually make it unsafe for a person to drive or operate machinery safely. Memantine may also affect a person's reactivity, hence special care should be taken when performing potentially hazardous activites.
  • Substantial changes to a patients diet, for example from a meat-eating diet to a strict vegetarian diet or vice versa, should be avoided, as this may affect the removal of this medicine from the body. If such changes are planned you should inform your doctor, so that the patient can be monitored and the dose of medicine changed if necessary.
  • The safety and efficacy of this medicine in children and adolescents under 18 years of age has not been established.

Use with caution in

  • Epilepsy or people with risk factors for epilepsy.
  • History of convulsions.
  • Decreased kidney function.
  • Condition where urine of normal acidity is not produced due to a kidney disorder, resulting in accumulation of acidic substances in the blood (renal tubular acidosis).
  • Severe infections of the urinary tract with Proteus bacteria.
  • Heart failure.
  • People who have recently had a heart attack.
  • Uncontrolled high blood pressure (hypertension).

Not to be used in

  • Breastfeeding.
  • This medicine is not recommended for people with severely decreased kidney function.
  • Ebixa oral drops contain sorbitol and should not be taken by people with rare hereditary problems of fructose intolerance.
  • Ebixa tablets contain lactose and should not be taken by people with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • The safety of this medicine for use during pregnancy has not been established. It is not recommended for use in pregnancy unless considered essential by your doctor. Seek medical advice from your doctor.
  • It is not known whether this medicine passes into breast milk. Women taking this medicine should not breastfeed. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

  • Dizziness.
  • Headache.
  • Constipation.
  • Sleepiness.
  • Increased blood pressure (hypertension).
  • Fatigue.
  • Vomiting.
  • Confusion.
  • False perceptions of things that are not really there (hallucinations).
  • Abnormal gait.
  • Fungal infections.
  • Abnormal blood clots in the veins (venous thrombosis or thromboembolism).
  • Seizures.
  • Inflammation of the pancreas (pancreatitis).
  • Depression.

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines the patient is already taking, including those bought without a prescription and herbal medicines, before they start treatment with this medicine. Similarly, check with your doctor or pharmacist before any new medicines are taken with this one, to ensure that the combination is safe.

The following medicines should be avoided in people taking memantine, as they act in the same way as this medicine and may therefore increase the chances of side effects:

  • amantadine
  • dextromethorphan
  • ketamine.

Phenytoin should be used with caution for the same reason.

Memantine may alter the effects of the following medicines. If any of these are taken in combination with memantine your doctor may need to alter the doses of either medicine:

  • levodopa and other dopamine agonists for Parkinson's disease, eg ropinirole, pramiprexole, apomorphine, bromocriptine
  • anticholinergic medicines for movement disorders such as Parkinson's disease (eg procyclidine) or intestinal cramps (eg atropine)
  • barbiturates, eg amobarbital, phenobarbital
  • antipsychotic medicines
  • dantrolene
  • baclofen
  • cimetidine
  • ranitidine
  • procainamide
  • quinidine
  • quinine
  • nicotine
  • hydrochlorothiazide.

This medicine may possibly enhance the effect of oral anticoagulant medicines such as warfarin. The manufacturer recommends that people taking this medicine in combination with an oral anticoagulant should have their blood clotting time (INR) closely monitored.

Other medicines containing the same active ingredient

There are currently no other medicines available in the UK that contain memantine as the active ingredient.