Donepezil improves the function of nerve cells in the brain. It works by preventing the breakdown of a chemical called acetylcholine (ah SEET il KOE leen). People with dementia usually have lower levels of this chemical, which is important for the processes of memory, thinking, and reasoning.

Memantine reduces the actions of chemicals in the brain that may contribute to the symptoms of Alzheimer's disease.

Donepezil and memantine is a combination medicine used to treat moderate to severe dementia of the Alzheimer's type.

Donepezil and memantine is not a cure for Alzheimer's disease. This condition will progress over time, even in people who take donepezil.

Donepezil and memantine may also be used for purposes not listed in this medication guide.

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Take this medicine at bedtime unless your doctor tells you otherwise.

You may take donepezil and memantine with or without food.

Do not crush, chew, or break an extended-release capsule. Swallow it whole.

To make swallowing easier, you may open the capsule and sprinkle the medicine into a spoonful of applesauce. Swallow right away without chewing. Do not save the mixture for later use.

Do not use a broken or damaged capsule.

If you need surgery or dental work, tell the surgeon ahead of time that you are using donepezil and memantine. You may need to stop using the medicine for a short time.

You should not stop using this medicine suddenly. Stopping suddenly may make your condition worse.

Store at room temperature away from moisture, heat, and light.

Usual Adult Dose for Alzheimer's Disease:

Patients stabilized on memantine (10 mg twice a day or 28 mg ER once a day) and donepezil 10 mg once a day:
-Memantine 28 mg ER-donepezil 10 mg orally once a day in the evening

Comments: This drug should be initiated the day following the last dose of memantine and donepezil administered separately.

Use:
Treatment of moderate to severe dementia of the Alzheimer's type in patients stabilized on
-Memantine (10 mg twice a day or 28 mg ER once a day) and donepezil 10 mg once a day, or
-Memantine (5 mg twice a day or 14 mg ER once a day) and donepezil 10 mg once a day in patients with severe renal impairment

You should not use donepezil and memantine if you are allergic to donepezil or memantine.

To make sure donepezil and memantine is safe for you, tell your doctor if you have:

• asthma or other breathing disorder;

• heart disease, or heart rhythm disorder;

• a history of seizures;

• stomach ulcer, or a history of stomach or intestinal bleeding;

• bladder obstruction or other urination problems;

• liver disease; or

• kidney disease.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether donepezil and memantine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe dizziness, drowsiness, weakness, trouble walking, slow or fast heart rate, sweating, confusion, agitation, hallucinations, unusual thoughts or behavior, weak or shallow breathing, fainting, or seizure.

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

donepezil and memantine may cause serious side effects. Stop using donepezil and memantine and call your doctor at once if you have:

• severe or ongoing vomiting;

• a light-headed feeling, like you might pass out;

• slow heartbeats;

• seizure (convulsions);

• painful or difficult urination;

• new or worsening breathing problems; or

• signs of stomach bleeding--severe heartburn or stomach pain, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds.

Common side effects of donepezil and memantine may include:

• nausea, vomiting, diarrhea, loss of appetite;

• headache;

• dizziness; or

• easy bruising.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Other drugs may interact with donepezil and memantine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.