Namzaric (donepezil and memantine) is an approved therapy for moderate to severe Alzheimer’s disease. Allergan markets it in the United States and Adamas elsewhere.

Namzaric offers temporary relief from Alzheimer’s symptoms. It does not prevent or slow the underlying cause of the disease: nerve cell death.

How Namzaric works

Alzheimer’s is a progressive neurodegenerative disorder. Its hallmark is nerve cell death in the brain that diminishes memory and a person’s ability to think.

Namzaric is a combination of two Alzheimer’s therapies, donepezil and memantine, that improve symptoms. Namzaric’s brand names are Aricept, marketed by Allergan, and Namenda, marketed by Eisai and Pfizer.

Donepezil offers a temporary reprieve from Alzheimer’s symptoms by improving communication between the nerve cells in the brain that are still healthy.

It inhibits acetylcholinesterase, an enzyme that breaks down the neurotransmitter acetylcholine. A neurotransmitter is a chemical that the brain uses to pass signals between nerve cells.

In Alzheimer’s, reduced acetylcholine signaling in the brain is thought to be one of the causes of reduced memory and judgment. By blocking acetylcholinesterase, donepezil increases acetylcholine levels, improving communication between brain cells.

Memantine regulates the neurotransmitter glutamate, which damaged nerve cells produce in abnormally high amounts. When glutamate binds to receptors for the protein NMDA on the nerve cell surfaces, the interaction allows a tightly controlled amount of calcium to enter the cells.

This process is essential to the cell signaling involved in memory and learning. Excessive glutamate binding leads to too much calcium entering nerve cells, disrupting the signaling process and causing damage and cell death. Memantine can prevent excess glutamate from accessing the NMDA receptors, reducing the amount of calcium entering cells and potentially reducing nerve cell damage.

History of Namzaric

The U.S. Food and Drug Administration approved Namzaric as a treatment for moderate to severe Alzheimer’s in December 2014. Initially, the agency authorized it for patients who were taking both donepezil and memantine, but it expanded the authorization in July 2016 to patients taking donepezil only.

The approval was based on a randomized, double-blind, placebo-controlled clinical trial in 677 Alzheimer’s patients. The trial assessed the safety and effectiveness of a combination of donepezil and memantine, compared with donepezil or an equivalent acetylcholinesterase inhibitor, and a placebo.

Patients taking the combo significantly improvement their cognition and function, compared with those taking a placebo, after 24 weeks. The yardsticks that researchers used to measure improvement were changes in patients’ scores on tests known as the severe impairment battery and the clinician’s interview-based impression of change plus caregiver input plus.

Other information

Namzaric is taken once a day either as an oral capsule or sprinkled on food. It is available in two doses — one twice as large as the other.

The most common side effects associated with Namzaric are nausea, vomiting, diarrhea, loss of appetite, headache, dizziness, and bruising.

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