I don't use a lot of memantine because NICE tell us not to, saying "Memantine is not recommended as an option for people with moderately severe to severe Alzheimer’s disease unless it is being used as part of a clinical trial (research)."
This means our commissioners don't pay us cash for this drug. Our GPs have it "red lighted" so if they entertain prescribing it wailing alarms and flashing lights go off, then stern Area Prescribing Committee pharmacists frog march in and rant at the GP until they stop having such ludicrous ideas, like prescribing memantine for their patients.
Still, I've a few patients on memantine, for good reasons. Well, I think they're good reasons. Anyway, the outcome is that the patients have stable cognitive function now, so there's been no progression of symptoms of dementia on memantine (but before memantine they were getting worse month on month). So, I continue to use it, a bit, because for a small number of folk it makes a meaningful difference.
It's just a small number of folk, partly because it's not funded (so I can never pass them back to the GP, so our hospital has to bear the cost of the drugs forever). The costs are not trivial. If I've a dozen patients on memantine then that'll cost as much as a secretary. Two dozen would pay for a nurse. Since we've no money for it, that's what it really means . . . if I want 24 folk on memantine, which nurse post do we lose to fund that?
But the other reason I've very few on memantine is, does it really work that well? I'm biased since over the years I've not used it on squillions of folk, but of those I have prescribed it form, for the vast majority it's done nothing. I'm sure it's not snake oil linement to cure all ills but it really does seem striking less efficacious than donepezil, galantamine and rivastigmine. Or is it just me?
This is a difficult one. I have been kebbabed in the system by being bullied into prescribing Rivastigmine, as a result of am argument between 2 consultants (neither of whom are, I'm afraid, the sharpest knives in the drawer).
We should not have to select between expensive drugs that might or might not work and half a secretary.
I guess it's the art of psychiatry - that's why we like it!
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