Memantine
Cognitive · NMDA antagonist
Tier A
Bottom line
Read Off Label grades Memantine as A (8.0/10) based on strong evidence, med benefit magnitude, and a low-risk safety profile.
Approved for moderate-to-severe AD; modest effect sizes on ADCS-ADL.
Studied, labeled, or reported-use context: 5-20 mg/day PO titrated — Rx; not individualized guidance.
What the evidence says
Approved for moderate-to-severe AD; modest effect sizes on ADCS-ADL. Off-label uses include augmentation in OCD and neuropathic pain. Healthy-person nootropic use is poorly studied and is not an approved indication; higher doses may produce cognitive blunting. A 2026 systematic review and meta-analysis (6 RCTs, n=288, 8-16 weeks, 5-20 mg/day; PROSPERO CRD420251147106) tested the OCD-augmentation claim directly and **found nothing**: pooled mean difference on the Yale-Brown scale was -3.74 points (95% CI -9.95 to 2.47), not statistically significant, with extreme heterogeneity (I2 = 97.9%). Responder analysis favoured memantine but was statistically unstable (RR 3.62, 95% CI 0.16-80.71 — an interval that spans essentially every possible answer). A treatment-resistant subgroup showed a larger but imprecise estimate from only two trials. Tolerability showed no excess adverse events or discontinuations. This confirms rather than changes the `Weak` off-label clause on this row, and is worth citing precisely because the OCD-augmentation use is widely repeated on the strength of individually promising small trials that do not survive pooling.
Mechanism
Low-affinity, uncompetitive NMDA receptor antagonist; blocks pathologic tonic glutamate activation while preserving physiologic bursts; also 5-HT3 and nicotinic antagonism
Studied, labeled, or reported dose & route
5-20 mg/day PO titrated
This records doses and routes described in studies, approved labeling, clinical practice, or documented use. It is not individualized guidance and does not establish safety; context changes with indication, formulation, health history, monitoring, and other medicines.
Citations
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Common questions
- What does the evidence show about Memantine's effects?
- Read Off Label rates the evidence for Memantine as Strong and the benefit magnitude as med, producing an overall grade of A (8.0/10). Approved for moderate-to-severe AD; modest effect sizes on ADCS-ADL.
- What safety findings are reported for Memantine?
- Memantine has a low risk profile in the database. Low (well-tolerated; dizziness, headache) Legal status: Rx.
- What doses or routes are reported for Memantine?
- 5-20 mg/day PO titrated This is context from studies, approved labeling, clinical practice, or documented use; it is not individualized guidance and does not establish safety.
- How does Memantine work?
- Low-affinity, uncompetitive NMDA receptor antagonist; blocks pathologic tonic glutamate activation while preserving physiologic bursts; also 5-HT3 and nicotinic antagonism
This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.