NMDA receptor antagonist
Noncompetitive antagonist of NMDA-type glutamate receptors, reducing excitotoxicity implicated in neurodegeneration
Moderate to severe Alzheimer’s disease (AD)
Vascular dementia, dementia with Lewy bodies (DLB), post-stroke apathy, catatonia (second-line)
Oral tablets, oral solution, extended-release capsules
Start at 5 mg p.o. daily; titrate weekly as tolerated to 10 mg twice daily (20 mg/day)
5–20 mg/day
Half-life approximately 60–80 hours; primarily renal excretion; dose adjustment required in renal impairment
Dizziness, confusion, headache, constipation, fatigue
Rare hypersensitivity reactions
Monitor for tolerability, especially in elderly and medically complex patients; renal function monitoring recommended in severe impairment
None
May improve cognitive symptoms in AD and vascular dementia. Limited evidence supports use in post-stroke cognitive impairment, Parkinson’s disease dementia, multiple sclerosis (MS), and traumatic brain injury (TBI)-related cognitive decline. Monitor closely for tolerability in elderly and medically complex patients.