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I plan to ask her doc if we can do this. She's already on the generic for Aricept with no problems for a few years now. I'll have to say I've noted more recent anger/aggression and am suspecting the Namenda XR after reading some comments on this forum. Right now am planning on giving her the Namenda XR every other day instead of every day to see if this might help a bit. The anger is a new thing for us. She checked out fine the other day (no UTI). Otherwise, she seems to be doing alright. Of course, the price difference down to the generic would be nice if the doc is agreeable. Any experience you folks have with this would be appreciated. I'd rather she be off the stuff completely but know she must at least be weaned. She does well physically, can feed herself and is still continent.

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Wow, just want to thank you for your question and the many answers. I am just beginning on this journey. We are just about to start Nameda, I appreciate all your advice and information.
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Wow, can't believe the price of the generic Namenda, had no idea but didn't check prices. Mom is still on the Namenda XR 28 mg, and we just refilled it for 90 days at $250, so I guess that price isn't so bad after all (she's Aetna Medicare/Express Scripts, retired school bus driver with evidently pretty good coverage). Her doc was not okay with dropping it or the Aricept generic and said there'd been a more recent study that said the combination of Aricept/Namenda is still a good thing, so I couldn't challenge her. Mom's quiet at this point, eating well, sleeping through the night with no mirtazapine or Ativan for quite awhile now, walking and talking well for the most part, so I guess I just knock on wood for the time being and continue what we're doing now, though her behavior can change on a dime.
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My husband with early on set FTD has been taking the generic Menantine 10 mg for about 2 yrs now and not sure if it really helps him or not but he doesn't have side effects. The cost through Express Scripts if 384.00 for 90 days. Just checked the Namenda ER 21 mg. and the cost would be 1019.00 for 90 days. No generic will be available until after 2025. Our only choice is continuing the generic.
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Letitia, a few years back, the neurologist had started her on Depakote and wanted to increase the dosage. I didn't like how she did even on small doses, and the neurologist seemed none too happy with me when I resisted. I didn't care for his pushy nurse, anyway, and the visits there seemed almost pointless after that. We switched to an internist/gerontologist. I do have a bottle of mirtazapine that her old family doc prescribed for its side effect of weight gain. That works well when she gets extra angry and anxious, and I love it when she eats well. She will sleep well and quiet down for a day or so, stops the constant jabbering, and the gerontologist is okay with my giving it this way. I'm hoping the gerontologist will be open to stopping the Namenda or cutting the dose or trying the generic. I'm not expecting it to help much at all anyway at this point. I think the hallucinations will be an ongoing thing anyway, just hate that anger. Most of the time, the imaginary folks she entertains are friendly, and I can take that.
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Does your mother see a psych nurse? If not she should. You may really want to investigate having her take an anti-psychotic. Particularly if she is hallucinating. I resisted it for a long time but a low dosage made an enormous difference in my mother's behavior. With the type of conversations you are describing you may really want to consider it. My mother also had a very bad reaction to Namenda. We had to take her right off of it. It wasn't physical reaction as much as it was an emotional one. She got very upset but couldn't really tell us why other than to take about the nebulous (and menacing) "them." This was an immediate reaction (2-3 days) but I wonder if the Namenda could be causing problems for your mother. Some people's tolerance to a drug changes over time. Just a thought. Good luck to you.
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Again, thank you all very much for your information! I'm really hoping the doc will be okay with the change to the generic when she's finished with these. I get what you're saying about the tiers, though, mar126, but am waiting to hear back from Express Scripts with her Aetna Medicare and this new 2016 formulary. I sure can't say we saw much improvement from the time she was taken off the Namenda 10 mg and placed on the XR version. I guess she's holding steady but the price continues to climb. I'm really hoping that we can try the generic and that this doc is alright with it.
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You may be able to save with mail order. Worth a shot.
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My wife was first prescribed Namenda XR late last year. She had not been on Namenda before. but had bad side effects to XR, nausea, diarrhea, headache. After discussing it with the Doc, he gave us a 10 mg Namenda prescription which was unavailable at the time locally. We get generic version (Memantine) from Canada for $0.55 per pill. She takes 1.5 pills per day without bad effects. (I can't see any good effects, either.) Her balance is poor, difficulty walking without support, speech is very poor. Watches TV most of the day, nodding off occasionally.
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With all the prescription companies I deal with, if there is a generic that is what the pharmacy is required to give u. If a doctor feels you do better with a namebrand he must contact ur insurance and tell them why.
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Hey Cindy. Pharmacist Jim here. Namenda generic (Memantine) should save you some $$. Only drawback is giving it 2X daily versus once a day on the Namenda XR. Looks like the generic might run anywhere from $60+ per month (cash price) for 60 tablets (without insurance). Hopefully Mom responds to generic and has good luck with generic. Hang in there!
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Cindy, another thing you could try is putting your mom on a very bland diet. I noticed my husband would act up more when he ate pizza or drank sodas. In early 2013 he decided I wasn't his wife and had to leave, it went on for weeks. That stopped when he quit drinking lemonade!
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Wow, that is expensive! You should be able to request a drug tiering exception since she is already on the medication. Call the insurance company and ask for the form. The exception gives a annual extension so that you get the drug at the same tier as you are on now. For example, tier 1 is generic and tier 5 is specialty. I think this is medicare terminology.
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Thanks for your responses. Mart, thanks for the good details about your hubby. I'd give anything if mom would at least take a nap for a half hour per day for me. She has never stopped chattering from the time she gets up, some days nonstop all day and into the evening. I've tried to get some Xanax with no success whatsoever to have no hand for the especially bad sundowning. I do have an old prescription for mirtazapine, and one of those will cause her to be dopey for 2 days; on that, at least we get no chattering and it certainly does help anxiety. I don't resort to mirtazapine unless she goes for several days or nights with the pacing. Now we have this anger thing with talking about killing everybody, the house is on fire, there's a dead baby in the bedroom. I take her out daily, we walk then get in the car to see my sister and fix lunch, shop, etc Mom will continue with the goofy morbid rambling the whole time some days. The doc has never witnessed any bad anxiety, of course, mom always checks out well in the office. Will keep in mind what you say about the XR. Every single patient must be different. Mom was never at any time unable to talk, walk or feed herself all these years.
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The neurologist we used to see prescribed the 10 mg tab as far back as 2008, then when the XR came in, he switched her to that, so on the XR for maybe 3 years now. The internist we now see kept the XR on board. Maybe I'm just bugged by the fact that mom's insurance will probably not cover the XR starting in 2016, that's why my question about dropping it back to 10 mg and even trying the generic to see what happens. Yup, I don't want to see her lose what she has left physically. . Not keen on paying $828 for 90 days' worth, thus the question about trying the generic that Express Scripts will cover, and it will cover the memantine hcl 10 mg cheaply. And yup, I'm a cheapskate, as is mom. We never got to try the generic in the first place, and she might be able to take that just as easily with the same results, which at this time I'm thinking are few anyway. Will approach the doc when this prescription runs out or if mom gets angrier and more physically combative, which may have nothing to do with the Namenda anyway. Sure is a guessing game.
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Cindy, the XR after Namenda means extended release so that it goes into the patients system slowly. Namenda XR comes in two strengths 21 mg and 28 mg. If she is on the 28 mg perhaps you should talk to the doctor about trying the 21 mg. But do not change to every other day unless you talk to the doctor. Everyone's brain is different, but for my husband, Namenda has been a very effective medication. He began taking Namenda in 2011 and it improved my husbands attention span, his speech and his motor control. We switched to the XR version from the twice per day original as soon as it was available with better results. My husband is in the late stages and sleeps about 17 hours/day. His doctor recently took him off Namenda to see if his awake time would improve. He still sleeps 17 hours per day, but can no longer communicate with me and is in a total fog, this happened within 3 days of stopping Namenda. So in my husband's case, Namenda XR was definitely worthwhile. If you feel that the Namenda XR is causing problems, do not switch to the twice per day immediate release. With the twice per day, the medication levels with swing up when the tablet is taken and down when it wears off. Just another comment, when my husband took the twice per day version, he had a lot of anxiety for which he was prescribed Xanax. After he switched to Namenda XR, the anxiety went away. Now that he is totally off of Namenda, his anxiety has suddenly come back and I am back to giving him Xanax.
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Cindy how long has your mom been on Namenda? While someon this forum notice a significant decline when discontinuing Namenda, others don't.

My mom's doc does not think it is doing mom any good any longer. She has been taking it probably six to eight years, two years is what mom's doc recommends. She has continued to take it primarily because of the steep decline some see. If it is not broke, don't fix it.
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