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Namenda (memantine): A Potential NEW Treatment for Fibromyalgia

  [ 108 votes ]   [ 15 Comments ]
By Richard N. Podell, M.D., MPH • www.ProHealth.com • June 11, 2015


Namenda (memantine): A Potential NEW Treatment for Fibromyalgia
Namenda (memantine) is a well established, treatment for moderate to severe Alzheimer’s Disease. Namenda acts to reduce the activity of a set of receptors in the brain and spinal cord called NMDA receptors.

Overstimulation of NMDA receptors is believed to contribute to the increased pain sensitivity in Fibromyalgia. Therefore, treating Fibromyalgia patients with memantine should, in theory, decrease Fibromyalgia pain.

But, for the last decade no one was willing to invest the funds needed to put this theory to the test. But, now that has changed. A very capable Spanish research team has done a double-blind study. The results: Fibromyalgia patients treated with memantine had less pain, better cognition and better day-to-day function compared to a control group, who took a placebo.

If these results are confirmed by future studies – as always the funding issue – memantine could quickly become a mainstay choice Fibromyalgia treatment.

This key research study was done in Spain. Subjects who met the American College of Rheumatology 1990 case definition for Fibromyalgia were recruited to take either memantine or a placebo.

During the six-month trial subjects taking memantine had substantially less pain, improved cognitive ability, and better day-to-day function than did patients taking a placebo. Statistically significant improvement occurred within the first month and persisted throughout the entire six months long trial.

Memantine’s side effects tend to be mild. There are relatively few adverse interactions with other drugs. So, if these encouraging results are confirmed by further studies, Namenda (memantine) could quickly become a mainstay treatment.

Dr. Barbara Olivan-Blazquez, Dr. Javier Garcia-Campayo and their team from Zaragosa University recruited about 60 long-term fibromyalgia patients. Half received memantine, the others took a placebo.

They measured pain status in two different ways. First, they used a visual analogue scale where patient rate their subjective perception of pain on a scale of zero to 10. Zero means no pain. Ten is the worst pain possible.

After one month on memantine, the average visual analogue score decreased from 6.56 to 4.83. That is, the memantine patients reported less pain. In contrast, subjects taking placebo modestly increased their pain score from 6.48 to 6.64. The difference favoring the memantine group was highly significant (P=0.001). Significant differences favoring the memantine group continued throughout the six-month long study.

A second way to measure pain was to pump up a blood pressure cuff. At baseline, the memantine group subjects complained of pain when the blood pressure cuff average reading was 97.9 millimeters of Mercury (mmHg). One month later, it required an average blood pressure of 112 mmHg. before pain was noted. Thus, pain sensitivity had decreased. Patients on the placebo showed the opposite – a mild increase in their sensitivity to blood pressure cuff induced pain.

The degree of pain improvement was moderate for most memantine patients, although it was dramatic in a few. Only sixteen percent of the memantine-treated subjects achieved a 50% improvement in pain (5 of 31subjects). BUT none (0%) of the subjects on placebo had that much improvement.

Subjects on memantine also did significantly better than those on placebo for the mini-mental status test of cognitive function, on a depression scale and on several measures of functional activity. The bottom line: Subjects taking memantine tended to feel better while also being more active.

Is it reasonable for a physician to consider using memantine as an “off label” treatment for fibromyalgia? We have only one fairly small study. So we cannot say for sure if memantine “really works.” But, as medicines go, memantine is considered to be fairly safe. Among Alzheimer’s patients, the most common side effects are dizziness, headache, confusion and constipation. Adverse drug interactions are few. But one should avoid mixing memantine with other NMDA receptor antagonist medicines such as amantadine, ketamine and dextromethorphan (the cough suppressant in Delsym).

The Spanish researchers started treating at 5 mg once daily. They titrated over one month to a final dose of 10 mg twice daily. Since people with fibromyalgia tend to be very sensitive to medicine side effects, I would tend to increase the dose even more slowly until we are sure that the patient tolerates the medicine.

The big obstacle I foresee is how to gain funding sufficient to repeat the Spanish study. Memantine is available as a generic. So there may be little incentive for Forest Laboratories (who makes brand name Namenda) or the generic manufacturers to spend the millions of dollars that would be needed to obtain FDA approval for them to promote memantine as a Fibromyalgia treatment.

Happily, the Spanish government provided major financial support for the Zaragosa research.

We do owe profound thanks to Dr Olivan-Blazquez, Dr. Garcia-Campayo and the Zaragoza group for putting memantine on our map.

I hope that we at ProHealth.com can help create a mechanism through which physicians and patients who take memantine “off label” can tell others in the Fibro community how their treatment went.

This is the Key Article:

Olivan-Blazquez, B…. Garcia-Campayo, J, Efficacy of memantine in the treatment of fibromyalgia: A double-blind randomized, controlled trial with 6-month follow-up. Pain 155 (2014): 2517-2515.

You can see the complete accepted but unedited manuscript at: http://www.thblack.com/links/RSD/Pain2014_inpress_memantine4FM-1stCT-32p.pdf

Additional References:

Fayed, N…Garcia-Campayo, J, Changes in Metabolites after Treatment with Memantine in Fibromyalgia. A double-blind randomized Controlled Trial with Magnetic Resonance Spectroscopy with a 6-month follow-up, CNS Neuroscience & Therapeutics, 20(2014): 999-1007

Serra, G, …Kahn, D, Memantine in the Treatment and Prophylaxis of Bipolar II Disorder and Comorbid Fibromyalgia: A case Report, Journal of Psychiatric Practice 20 (2014): 232-6
_______________

Richard Podell, M.D., MPH is a graduate of Harvard Medical School and the Harvard School of Public Health. He has been treating patients with ME-CFS and Fibromyalgia for more than 20 years. A clinical professor at New Jersey's Robert Wood Johnson Medical School, Dr. Podell see patients at his Summit, NJ and Somerset, NJ offices. His website is www.DrPodell.org



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Article Comments Post a Comment

Namenda Study
Posted by: remiaz12
Jun 16, 2015
This article is the first to truly offer me hope, in a way that I can understand. How can we raise funds to continue research, and thank you so much for doing the study and printing the article!!!
Reply Reply

Fibro and help with my recall
Posted by: marybeej523
Jul 8, 2015
I'm 61 and have had Fibro for many years. I am now having trouble with instant recall/memory. Very interested in the new drug from Spain, and would be glad to get some help there.
Reply Reply

New Fibro Treatment
Posted by: vivgroves
Jul 8, 2015
Where can I buy it?
Reply Reply

Namenda
Posted by: rositunga
Jul 8, 2015
NEW YORK--(BUSINESS WIRE)--Forest Laboratories, Inc. (NYSE:FRX), a leading, fully integrated, specialty pharmaceutical company largely focused on the United States market, today announced that it plans to discontinue the sale of NAMENDA® (memantine HCl) 5 mg and 10 mg tablets effective August 15, 2014. Forest has notified the U.S. Food and Drug Administration of this decision. The oral solution of NAMENDA and once-daily NAMENDA XR® (memantine HCl) extended-release capsules will continue to be available. Both NAMENDA and NAMENDA XR are indicated for the treatment of moderate to severe Alzheimer’s disease.

WHY ??
Reply Reply

New Hope
Posted by: Eviek
Jul 9, 2015
Hoping there aren't many side effects like sweating and weight gain though! This is hopeful to see research is being done for fibromyalgia.
Reply Reply

Namenda
Posted by: emilycahan
Jul 9, 2015
I would love to try this medication for both Fibrro and cognitive decline. Medicare does not cover it. It's expensive. How can I get some help in obtaining it? Thanks.
Reply Reply

Namenda
Posted by: Venetta
Jul 9, 2015
I AM SO HAPPY TO HEAR THIS!!! I was prescribed Namenda a few years ago by a specialist (who knew that I had Fibro) who was concerned about my memory loss.
I have to say, not only did it seem like my memory improved, but it seemed like I had more energy (perhaps from not being in so much pain!) but when that doctor left and a new doctor replaced her (that is the inconvenience of going to a "teaching" medical center) they pulled me off saying "I did not have Alzheimer's!".
I was a good little patient back then and just let them do what they thought was best. NOW that I have heard about this successful trial, I am going to speak to my GP about prescribing it for me again! It would be fantastic if I could trade 2 or 3 medications for this one!!
Reply Reply

cost
Posted by: hotcrossbuns
Jul 9, 2015
If Medi Medi insurance wont pay what is the price ?
Reply Reply

cost
Posted by: hotcrossbuns
Jul 9, 2015
It sounds promising 4 fibro. What is the price w/o/ insurance ?
Reply Reply

Can this work if you have both fibro and cfs?
Posted by: sagallagherwarden
Jul 9, 2015
I would like to try it ! I have cfs , fibro and osteoarthritis! My cfs includes brain fog for sure!! Sounds hopeful! How can we get dr to prescribe it anyway?
Sherry
Reply Reply

Namenda as off-label for fibro
Posted by: hvelez
Jul 9, 2015
My fibro specialist tried me on Namenda about a year ago. He'd explained that, although it is an Alzheimer's medication, research showed that it was promising as an off-label drug for fibro (exactly as this article says.)
It didn't change symptoms for me, and, as I'd rather be on as little meds as possible,I came off of it. However, the article says that it can be raised to 10 mg. I was on 5mg. In definitely willing to try it again after reading further information.
Reply Reply

Namenda study.
Posted by: PIB
Jul 10, 2015
I know our insurance company, Anthem, would not approve Lyrica for me because they felt it was unnecessary! I can see the same problem happening with Namenda if doctors try prescribing it off label for Fibromyalgia.
Reply Reply

Namenda
Posted by: mannopd
Jul 27, 2015
The link provided that is suppoed to be for the complete report is actually only the 2013 publication of the study protocol, with no results.
Reply Reply

 
Corrected links
Posted by: ProHealth-Editor
Jul 28, 2015
Thank you for pointing out the problem with the link, mannopd. We have double checked and corrected all of the links provided with the article. While the full final article published in the journal Pain is not available without paying a fee, we have provided a link to the accepted but unedited manuscript.

 


Side Effects
Posted by: LaurieBala
May 18, 2016
I will be 56 this Sunday May 22nd. I have had this chronic pain (fibro) since 2004...12 years. If I didn't take anything for my pain I could not function and would wish to end it all that is how bad my pain levels can get. I had breast cancer 2 years ago, now cancer free so far. While taking Chemo treatments I had severe pain the first 5-6 days after a treatment and then for 2 weeks I HAD NO PAIN..it was wonderful..I told my doctor there is something in the chemo that switches off the pain receptors and more research needs to be done with that fact. I have no idea if any other person out there has had chemo and experienced what I had experienced but that would be interesting to find out.
I have started using Namenda RX 3 weeks ago. I have one more week to get to the maximum dosage of 28mg.
I have had improvements in having less brain fog, a clearer mind and some less pain, not a whole lot less but some. I' am hoping to have less pain once I hit the 28mg dosage but we will see. Even though I have seen some changes I'm just not sure if I will continue this medicine beyond the 4 weeks starter kit. Again we will see. Side Effects for me have only been so far is a little dizziness in the afternoon.
Good luck and many blessings...maybe I can come back with more updates it anyone here at this site is interested. LJB
Reply Reply


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