![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by zonked on April 30, 2014, at 13:29:24
In plain English, what does Namenda (memantine) *do* to help people with brain damage (alzheimer's, and in my Mom's case, brain tumor damage) to help memory and cognition?
I am familiar with the NMDA receptor. My understanding is that it prevents excess firing somehow and thus cell death.
Someone here will know.
Also when Mom started on Namenda her neurologist suggested that at some point he may add Aricept to help. I am wondering if that's worthwhile, given her prognosis and that she appears to be doing better on Namenda.
-z
Posted by ed_uk2010 on April 30, 2014, at 14:47:40
In reply to Can someone explain Namenda's MOA?, posted by zonked on April 30, 2014, at 13:29:24
Interesting. Aricept (donepezil) is the usual first-line choice for mild to moderate dementia, especially in Alzheimer's disease. Memantine is normally reserved for advanced Alzheimer's disease.
Posted by zonked on April 30, 2014, at 14:51:01
In reply to Re: Can someone explain Namenda's MOA?, posted by ed_uk2010 on April 30, 2014, at 14:47:40
> Interesting. Aricept (donepezil) is the usual first-line choice for mild to moderate dementia, especially in Alzheimer's disease. Memantine is normally reserved for advanced Alzheimer's disease.
This neurologist prefers to start with Memantine and then add Aricept; I don't know if that's standard practice - but in 5 years of being diagnosed with brain cancer, he's been her best doctor (along with her neurosurgeons)...
-z
Posted by Phillipa on April 30, 2014, at 17:31:24
In reply to Re: Can someone explain Namenda's MOA? » ed_uk2010, posted by zonked on April 30, 2014, at 14:51:01
Maybe it's better for those with advanced brain cancer? Phillipa
Posted by klein on April 30, 2014, at 18:36:34
In reply to Can someone explain Namenda's MOA?, posted by zonked on April 30, 2014, at 13:29:24
> In plain English, what does Namenda (memantine) *do* to help people with brain damage (alzheimer's, and in my Mom's case, brain tumor damage) to help memory and cognition?
>
> I am familiar with the NMDA receptor. My understanding is that it prevents excess firing somehow and thus cell death.
>
> Someone here will know.
>
> Also when Mom started on Namenda her neurologist suggested that at some point he may add Aricept to help. I am wondering if that's worthwhile, given her prognosis and that she appears to be doing better on Namenda.
>
> -zGah, I find NMDA receptors and mematine's moa pretty hard to grasp. Maybe the easiest way to get how memantine works is to use Stahl's phrase: "artificial magnesium", that makes sense to me. If you google ""artificial magnesium" memantine" you should find an excerpt from one of his books, he explains it all very clearly and simply.
Posted by Louisiana Sportsman on May 1, 2014, at 3:44:42
In reply to Re: Can someone explain Namenda's MOA? » zonked, posted by klein on April 30, 2014, at 18:36:34
Stahl's phrase: "artificial magnesium", that makes sense to me. If you google ""artificial magnesium" memantine" you should find an excerpt from one of his books, he explains it all very clearly and simply.
>I love Stahl! Have you read Essential Pharmacology (1996)? I've also read some of his stuff online.
It took me more than two days to grasp the first two chapters of his 1996 book lol. You'd have to see it to know what I mean lol.
Posted by klein on May 1, 2014, at 8:27:50
In reply to Re: Can someone explain Namenda's MOA?, posted by Louisiana Sportsman on May 1, 2014, at 3:44:42
> Stahl's phrase: "artificial magnesium", that makes sense to me. If you google ""artificial magnesium" memantine" you should find an excerpt from one of his books, he explains it all very clearly and simply.
> >
>
> I love Stahl! Have you read Essential Pharmacology (1996)? I've also read some of his stuff online.
>
> It took me more than two days to grasp the first two chapters of his 1996 book lol. You'd have to see it to know what I mean lol.
>
>Stahl rocks!I haven't read Essential Pharmacology cover to cover, just the random chapters I need. I have read "The Prescriber's Guide" back to back though, just to double-check and keep tabs on my pdoc lol :P
Which reminds me! Speaking of NAmenda and NMDA, this little hoot is from Stahl's Neuroscience Education Institute. You can't get any more simpler and fund than this:
http://www.youtube.com/watch?v=oiA_Sps7EvU&list=PLD7C2A877EDF13DD1
:D
Posted by SLS on May 1, 2014, at 12:20:00
In reply to Can someone explain Namenda's MOA?, posted by zonked on April 30, 2014, at 13:29:24
Guess:
There is probably an excess of glutamate being leaked out of cells and causing progressive deterioration through neurotoxicity and oxidative damage. Memanting would dampen this at NMDA glutamate receptors.
I would seriously look at minocycline to reduce inflammation, buffer glutamate release, and reduce neurotoxic degenerative processes, including oxidative damage produced by free radicals. Lamictal might help with mood by reducing active release of glutamate.
1. Is neuroprotective.
2. Reduces brain inflammation
3. Reduces the number of glutamate receptors.
4. Demonstrates antidepressant properties in mouse models of depression.
5. Is reported to act synergistically with noradrenergic antidepressants to treat depression - desipramine (but not fluoxetine).
6. Is reported to act synergistically with NMDA antagonists.
7. Reduces glutamate excitotoxicity by reducing the formation of quinolic acid, a NMDA agonist.
8. Reduces mitochondrial release of cytochrome C.
9. Modulates several signaling pathways.
10. Reduces microglial activation.
11. Has been reported anecdotally to successively treat depression.
12. Reduces the expression of lipopolysaccharide-induced pro-inflammation cytokines, an effect that acts as an antidepressant in animal models.
13. Increases neurite growth in response to nerve growth factor (NGF).
14. Inhibits high levels of PKC and GSK-3 alpha;
15. Decreases nitric oxide synthetase, thereby reducing free radicals which damage neurons and glia.
16. Reduces glutamate release.
- Scott
Posted by SLS on May 1, 2014, at 12:27:05
In reply to Re: Can someone explain Namenda's MOA? » zonked, posted by SLS on May 1, 2014, at 12:20:00
N-acetylcysteine (NAC) might also be helpful to increase levels of the antioxidant, glutathione, and reduce neurotoxic homocysteine.
- Scott
Posted by zonked on May 1, 2014, at 12:34:17
In reply to Re: Can someone explain Namenda's MOA? » zonked, posted by SLS on May 1, 2014, at 12:20:00
As always, I thank you, Scott, for being such a great source of information. It is interesting that you mentioned Lamictal - after her first surgery (within days of having a rule-out CT scan for resistant headaches, followed by various MRIs and all kinds of tests), she was put on Keppra. Initially I believed she suffered from Kepp-rage (and may still be, she's at the max dose now), I asked her Neurologist: "Why not Lamictal?" - it's his second choice, he explained, due to risk of the rash syndrome; and being that she was already allergic to two other anticonvulsants (Tegretrol/Trileptal) he didn't want to risk it.
He is very conservative, but if her seizures get worse, he won't raise the Keppra and I will ask about adding Lamictal as a second anticonvulsant might help control her seizures. He leaves mood meds to the psychiatrist, but as she is not bipolar, I doubt he will prescribe it independently.
Oh, I forgot, she is also on gabapentin - prescribed initially for mood prior to discovering cancer but it's also now probably helping her siezures. When I find out what lobe(s) the tumor is in, I used to know, I will repost. Somewhere in the temporal lobe, to be sure.
-z
> Guess:
>
> There is probably an excess of glutamate being leaked out of cells and causing progressive deterioration through neurotoxicity and oxidative damage. Memanting would dampen this at NMDA glutamate receptors.
>
> I would seriously look at minocycline to reduce inflammation, buffer glutamate release, and reduce neurotoxic degenerative processes, including oxidative damage produced by free radicals. Lamictal might help with mood by reducing active release of glutamate.
>
> 1. Is neuroprotective.
> 2. Reduces brain inflammation
> 3. Reduces the number of glutamate receptors.
> 4. Demonstrates antidepressant properties in mouse models of depression.
> 5. Is reported to act synergistically with noradrenergic antidepressants to treat depression - desipramine (but not fluoxetine).
> 6. Is reported to act synergistically with NMDA antagonists.
> 7. Reduces glutamate excitotoxicity by reducing the formation of quinolic acid, a NMDA agonist.
> 8. Reduces mitochondrial release of cytochrome C.
> 9. Modulates several signaling pathways.
> 10. Reduces microglial activation.
> 11. Has been reported anecdotally to successively treat depression.
> 12. Reduces the expression of lipopolysaccharide-induced pro-inflammation cytokines, an effect that acts as an antidepressant in animal models.
> 13. Increases neurite growth in response to nerve growth factor (NGF).
> 14. Inhibits high levels of PKC and GSK-3 alpha;
> 15. Decreases nitric oxide synthetase, thereby reducing free radicals which damage neurons and glia.
> 16. Reduces glutamate release.
>
>
> - Scott
Posted by Dr. Bob on May 3, 2014, at 9:45:25
In reply to Re: Can someone explain Namenda's MOA?, posted by Louisiana Sportsman on May 1, 2014, at 3:44:42
> I love Stahl! Have you read Essential Pharmacology (1996)?
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book, a movie, or music without using this option, I post this to try to make sure he or she is at least aware of it.
Bob
Posted by zonked on May 3, 2014, at 9:53:35
In reply to Re: Can someone explain Namenda's MOA?, posted by Louisiana Sportsman on May 1, 2014, at 3:44:42
It's very expensive, but I have read through it.
He makes very complicated stuff easier to understand. I still don't "get it" the way a neuroscientist would but I have a much better idea thanks to him. Some of the drawings are funny, too, in a non-offensive way.
-z
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.