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Namenda XR
Posted: Wednesday, May 9, 2012 5:06 PM
Joined: 4/18/2012
Posts: 21

I dug a little deeper into Myriam's post below and learned that a new, extended release version of Namenda is available called "Namenda XR".  It comes in a 28 mg dose, which is quite a bit more than the immediate release pills that are 10 mg each taken twice daily.


I could not find a direct comparison of the efficacy between the above.  All that I found are statements like this one: 


"The results indicate that patients treated with NAMENDA XR® experienced substantial benefits in cognition as compared to placebo." 


However, one would think that 28mg of xr would do more than 20 mg of non xr.


Can anyone find more difinitive info than the above?





Mimi S.
Posted: Friday, May 11, 2012 10:02 AM
Joined: 11/29/2011
Posts: 7027

Hi John,

I don't know the answer to your question, but it sounds suspiciously like what happened to Aricept. When the drug was going generic, the manufacturers came out with the 23 gm. pill. it is higher in price, but there is very little/no evidence that there is much, if any improvement.

Posted: Sunday, May 13, 2012 9:16 AM
Joined: 3/7/2012
Posts: 2715

I asked the neurologist last week about the 23mg Aricept pill as opposed to two 10mg.  He said just because its new out doesn't mean its better.  I hadn't thought of it that way.  He said he likes the 10mg twice a day & will continue with that.  The evidence is there to support that, not the 23 mg.


Just tossing that out.  eagle

Lane Simonian
Posted: Sunday, May 13, 2012 10:16 AM
Joined: 12/12/2011
Posts: 4998

I agree with Mimi and eagle.  Higher doses of a drug often do not produce better results and usually have more side effects.  The following study found that namenda (up to 20mg) does not reduce clinically significant agitation. 


Cummings (see Myriam's post Three Important Findings in Alzheimer Disease) found that namenda (28mg) did have a positive effect on agitation.  However, previous studies using lower doses produced the same results.  It's probably not the difference in dosage but the degree and cause of agitation that produced the different results from that of the plos study.  Namenda may reduce certain forms of agitated behavior and not others. 


The 28mg dose of namenda has been out for a couple of years now, so if there were any significant improvements in cognition with the higher dose you would think there would be some published results by now (and so far I cannot find any). 

Posted: Friday, May 25, 2012 2:16 PM
Joined: 1/5/2012
Posts: 27

Big pharma does it again - another way to make big bucks on the backs of sick people.  A better question might be why does the FDA allow this - hint guess where FDA folks go after they retire - to work for the drug companies they were supposed to regulate.
Posted: Sunday, February 7, 2016 3:49 PM
Joined: 2/7/2016
Posts: 1

I agree it's "big pharma" again. This blog post broke it down pretty well for me.


Lane Simonian
Posted: Sunday, February 7, 2016 4:26 PM
Joined: 12/12/2011
Posts: 4998

Welcome, robbeoconell and thank you for posting the article--very good analysis on the part of the author.
Posted: Monday, February 29, 2016 8:35 PM
Joined: 2/27/2016
Posts: 9

Namenda's active ingredient is the same as you get in coconut oil as far as I know.
Have they changed it??

Lane Simonian
Posted: Tuesday, March 1, 2016 2:37 PM
Joined: 12/12/2011
Posts: 4998

Namenda is a different compound than the compounds in coconut oil but they act upon the same receptor.

If one wished to try coconut oil as a health supplement, virgin (unrefined) coconut oil would be preferable since it contains higher levels of beneficial “polyphenols” (specifically, ferulic acid and p-coumaric acid).

Polyphenols in coconut oil could be potentially useful for Alzheimer’s (and other diseases) since they act as antioxidants. Antioxidants help temper the harmful effects of inflammation, e.g., free radical production, which causes so much damage in Alzheimer’s and other diseases involving tissue degeneration.

Some other virgin oils have also been reported to be useful for lowering Alzheimer’s pathology in animal models. These include extra virgin olive oil and virgin grapeseed oil, both of which are high in polyphenol content as well. So, one benefit of coconut oil in Alzheimer’s could derive from polyphenols acting as antioxidants.

Ferulic acid is a better NMDA receptor antagonist than Namenda (so is eugenol in various essential oils and strains of medicinal marijuana).  This helps to prevent the further build up of oxidants and limits the further damage they do to the brain.  Ferulic acid like THC in medicinal marijuana improves behavior in people with dementia via a different mechanism.

 2011 Jul;11(3):309-14. doi: 10.1111/j.1447-0594.2010.00687.x. Epub 2011 Jan 28.

Effect of ferulic acid and Angelica archangelica extract on behavioral and psychological symptoms of dementia in frontotemporal lobar degeneration and dementia with Lewy bodies.



The behavioral and psychological symptoms of dementia place a heavy burden on caregivers. Antipsychotic drugs, though used to reduce the symptoms, frequently decrease patients' activities of daily living and reduce their quality of life. Recently, it was suggested that ferulic acid is an effective treatment for behavioral and psychological symptoms. We have also reported several patients with dementia with Lewy bodies showing good responses to ferulic acid and Angelica archangelica extract (Feru-guard). The present study investigated the efficacy of Feru-guard in the treatment of behavioral and psychological symptoms in frontotemporal lobar degeneration and dementia with Lewy bodies.


We designed a prospective, open-label trial of daily Feru-guard (3.0 g/day) lasting 4 weeks in 20 patients with frontotemporal lobar degeneration or dementia with Lewy bodies. Behavioral and psychological symptoms of dementia were assessed at baseline and 4 weeks after the start of treatment, using the Neuropsychiatric Inventory. The Neuropsychiatric Inventory scores were analyzed using the Wilcoxon rank sum test.


Treatment with Feru-guard led to decreased scores on the Neuropsychiatric Inventory in 19 of 20 patients and significantly decreased the score overall. The treatment also led to significantly reduced subscale scores on the Neuropsychiatric Inventory ("delusions", "hallucinations", "agitation/aggression", "anxiety", "apathy/indifference", "irritability/lability" and "aberrant behavior"). There were no adverse effects or significant changes in physical findings or laboratory data.


Feru-guard may be effective and valuable for treating the behavioral and psychological symptoms of dementia in frontotemporal lobar degeneration and dementia with Lewy bodies.

Heat processed ginseng (ginseng steamed at high temperatures for about three hours) contains ferulic acid, syringic acid, maltol, p-coumaric acid, and vanillin--the combination of which likely makes it a better treatment for Alzheimer's disease than coconut oil.

 2012 Nov;15(6):278-82. doi: 10.1179/1476830512Y.0000000027.

Heat-processed ginseng enhances the cognitive function in patients with moderately severe Alzheimer's disease.



Ginseng has been reported to improve cognitive function in animals and in healthy and cognitively impaired individuals. In this study, we investigated the efficacy of a heat-processed form of ginseng that contains more potent ginsenosides than raw ginseng in the treatment of cognitive impairment in patients with moderately severe Alzheimer's disease (AD).


Forty patients with AD were randomized into one of three different dose groups or the control group as follows: 1.5 g/day (n = 10), 3 g/day (n = 10), and 4.5 g/day (n = 10) groups, or control (n = 10). The Alzheimer's Disease Assessment Scale (ADAS) and Mini-Mental State Examination (MMSE) were used to assess cognitive function for 24 weeks.


The treatment groups showed significant improvement on the MMSE and ADAS. Patients with higher dose group (4.5 g/day) showed improvements in ADAS cognitive, ADAS non-cognitive, and MMSE score as early as at 12 weeks, which sustained for 24-week follow-up.


These results demonstrate the potential efficacy of a heat-processed form of ginseng on cognitive function and behavioral symptoms in patients with moderately severe AD.

Posted: Sunday, March 13, 2016 3:47 PM
Joined: 6/28/2015
Posts: 9

Thank you.  They increased my husband to 23 mg Donepezil this week but I was wondering why 2 of the 10 mg would not work just as well.


Mimi S.
Posted: Sunday, March 13, 2016 6:33 PM
Joined: 11/29/2011
Posts: 7027

The ten mg is now generic and less expensive. The 23 is full price

Check both the original price of the generic against the newer

Also unless the 23 is slow release, wouldn't't Two pills 12 hours apart be better ?

Posted: Thursday, April 21, 2016 2:34 PM
Joined: 4/19/2016
Posts: 4

a higher dose of Namenda caused my sister to start wandering at night-according to her nurse practionier that is--anybody else find this kind of problem?
Iris L.
Posted: Monday, May 16, 2016 2:18 PM
Joined: 12/15/2011
Posts: 17565

There is no functional difference between 20 mg of Namenda and 28 mg of Namenda XR.  The change to Namenda XR was made because Namenda was going generic.  There were discussions on the I Have Alzheimer's board ~ 2014 when this was happening.

Iris L.