Ebixa (memantine): drug treatment for Alzheimer's disease

Introduction

Ebixa is the brand name for the drug memantine. It is licensed for the treatment of moderately severe to severe Alzheimer's disease, and was launched in October 2002 by the drug company Lundbeck Ltd. It differs from the other drugs available in the UK for Alzheimer’s disease (Reminyl, Aricept and Exelon – see Information sheets 11, 14 and 17) which are all licensed for the mild to moderate stages of the illness.

Ebixa is not claimed to be a cure for Alzheimer's disease. It treats only the symptoms and there is no evidence to show that it could halt or reverse the process of cell damage that causes Alzheimer's disease.

This information sheet is for people with Alzheimer's disease, their families and carers, and for anyone else interested in the treatment of Alzheimer's disease. It updates an earlier version published in October 2002.

How does Ebixa work?

Alzheimer’s disease and some other types of dementia damage brain cells. This causes some cells to release too much of a chemical called glutamate, which carries messages between brain cells. Too much glutamate can damage cells further, because when it sticks to ‘docking sites’ on the surface of a cell, too much calcium can get into the cell and damage it. Ebixa sticks to the same docking sites, blocking glutamate, so that it can’t let too much calcium in. The docking sites are called ‘N-methyl-D-aspartate (NMDA) receptors’, and Ebixa is sometimes referred to as an ‘NMDA receptor antagonist’.

Who might benefit?

Ebixa is licensed only for people with Alzheimer's disease who are in the moderately severe to severe stages of the illness. It is not licensed for people with other kinds of dementia; however, its use has been investigated in people with vascular dementia.

What effect might Ebixa have?

The effect of the drug will vary for different people. Some will not notice an effect at all. Others may find that their condition improves, or that they stay the same when they would have been expected to get gradually less able because of the progression of Alzheimer's disease.

Since the other dementia drugs are designed for people in the early to moderate stages of Alzheimer’s disease, they would normally be stopped before the person starts taking Ebixa. However, some doctors think that it may be more effective to combine Ebixa with Aricept, one of the other drugs, although there is no conclusive evidence to support this view.

SIGN guideline

The Scottish Intercollegiate Guidelines Network (SIGN) is an organisation which produces guidelines and recommendations on how to treat medical conditions. These recommendations are then used by health professionals, such as doctors.

In producing its guideline on the management of patients with dementia, SIGN reviewed studies which investigated the effects of Ebixa.

• In people with moderate to severe Alzheimer's disease who took Ebixa for six months, there was a positive effect on activities of daily living; however, this effect was not clinically significant.
• In people with mild to moderate vascular dementia who took 20 mg of Ebixa for six months, there was a small effect on a number of outcome measures. However, again this effect was not clinically significant.

SIGN recommendation

The guideline development group concluded that there is currently insufficient evidence to recommend the use of Ebixa for the treatment of symptoms in people with dementia.

How is Ebixa taken?

Ebixa comes in 10 mg tablets. To start with, the person will probably be prescribed half a tablet every morning for one week, building up to one tablet twice a day in the fourth week and beyond. This is to reduce the risk of side effects. If Ebixa is taken twice a day, ideally it should be taken at breakfast time and in the afternoon or evening.

It also comes in drops for people who have difficulty with tablets. In this case, the person will usually start on 10 drops every morning for the first week, building up to 20 drops twice a day in the fourth week and beyond.

If a dose is missed, the person should wait and take their next dose at the usual time. Two doses should not be taken at the same time.

Are there any side effects?

Medicines can affect people in different ways causing side effects in some but not others. It is not possible to tell who will have side effects and who will not.

With Ebixa, the more common side effects include headaches, dizziness, tiredness, constipation and hallucinations but these are likely to settle down over time. Any side effects should be reported to the doctor.

Interactions with other drugs

It is important to tell the doctor about all the drugs that the person with Alzheimer's disease takes because Ebixa may interact with them. This includes prescription and non-prescription drugs, vitamins, herbal remedies or dietary supplements.

Examples of drugs it can interact with are anticonvulsants (taken by people who have seizures) and anticholinergics (taken by people with movement disorders or intestinal cramps).

Interactions with other conditions

People with kidney or heart problems, epilepsy or high blood pressure should consult their doctor about their suitability for Ebixa.

The doctor must be told of any previous or current diseases of the person with Alzheimer's disease and also if the person is going to have an operation which will require anaesthesia or is pregnant, trying to get pregnant or breastfeeding.

In addition, the doctor should be consulted before making a drastic change to the person’s diet (for example, putting him or her onto a vegetarian diet if he or she normally eats meat).

Overdose

If the person has taken too much Ebixa, contact a doctor or hospital straight away. Keep any remaining tablets and the packaging so that you can tell them how much he or she has taken. NHS 24 (telephone 08454 24 24 24) may be able to give you advice when your GP practice or health centre is closed.

Stopping the drug

It is best to discuss with the doctor when to stop the drug. However, it is possible to stop immediately if the person with Alzheimer's disease or his or her carer feels this is necessary. If this is the case, the doctor should be consulted as soon as possible.

How to get Ebixa

Ebixa is not generally available on NHS prescription in Scotland, because it is believed the benefits of taking the drug are too small to be cost-effective. Therefore, if someone with Alzheimer's disease wants to receive it, he or she may have to pay for it on a private prescription unless the specialist involved agrees to prescribe it on an NHS prescription.

Any doctor can, in theory, write a private prescription if he or she thinks the treatment would help the person and if the doctor is willing to accept responsibility for the decision to prescribe the drug.

A private prescription can be obtained through a consultant or other specialist, a private hospital, or GP. However, hospital doctors may not be allowed by their health boards to write private prescriptions for patients after assessing them at a NHS consultation. This could mean that the person with Alzheimer's disease has to pay for a private consultation.

GPs are not allowed to charge for writing a private prescription if the patient is registered for NHS care with that GP or another GP in the same practice. However, not all GPs are willing to issue private prescriptions, and some may feel they do not have the right expertise to prescribe Ebixa, as it is normally only prescribed by hospital specialists.

Private specialists will write private prescriptions if they consider the drugs would be beneficial. However, it is unlikely that they would do so without arranging to monitor the person with Alzheimer's disease for the effects of the drug. If the person with Alzheimer's disease is going to see a specialist privately, ask for a written estimate of any additional on-going costs associated with the prescription.

There are advantages to staying within the NHS system for dementia care, other than reduced cost and ongoing monitoring of your condition, such as getting access to other NHS services like community nursing, continence services and various therapies.

Take the prescription to the pharmacist or chemist, as you would with a NHS prescription.

Cost

Private prescriptions are not covered by the NHS prescription charge and are not supplied free to people who do not pay prescription charges. A dispensing fee on top of the full cost of the drug will also be charged. This could be in the region of £50. It may pay to shop around if you can, as dispensing charges can vary from pharmacy to pharmacy and even between branches of the same company.

The cost of one year’s treatment with Ebixa at 20 mg per day is £899.36.

The oral drops cost £61.61 for 50g (10mg/g) and £123.23 for 100g (10mg/g). The cost of one year’s treatment with the drops (at 20mg per day) is £899.51.