(FDA approved in bold)

• Alzheimer dementia (AD) (moderate or severe)
  
• Vascular dementia
  
• Parkinson’s disease related dementia
  
• Dementia with Lewy bodies (DLB)
  
• HIV dementia
  
• Migraine prophylaxis
  
• Neuropathic pain
  
• Attention deficit hyperactivity disorder
  
• Binge-eating disorder

• Binds preferentially to NMDA receptors, preventing glutamate from activating these receptors. The excitatory effects of glutamate are postulated to contribute to the development of AD and lesions such as neurofibrillary tangles
  
• Although symptoms of AD can improve, memantine does not prevent disease progression

• Weeks to months

• Continue to use but symptoms of dementia usually continue to worsen

• Non-pharmacologic measures are the basis of dementia treatment. Maintain regular schedules and routines. Avoid prolonged travel, unnecessary medical procedures or emergency room visits, crowds, and large social gatherings
  
• Limit drugs with sedative properties such as opioids, hypnotics, antiepileptic drugs and tricyclic antidepressants
  
• Treat other disorders which can worsen symptoms such as hyperglycemia, or urinary difficulties

• Addition of cholinesterase inhibitors may be beneficial. In one study donepezil plus memantine reduced the rate of progression compared to those taking donepezil alone
  
• Treat depression, if present, with SSRIs. Avoid tricyclic antidepressants in demented patients due to risk of confusion
  
• For significant confusion and agitation avoid neuroleptics (especially in Lewy body dementia) to avoid the risk of neuroleptic malignant syndrome. Atypical antipsychotics (risperidone, quetiapine, olanzapine, clozapine) can be used instead

• None required