Mechanism
of action
Memantine exerts its action through uncompetitive
NMDA receptor antagonism, binding preferentially to the NMDA receptor-operated
cation channels. Prolonged increased levels of glutamate in the brain of
demented patients are sufficient to counter the voltage-dependent block of NMDA
receptors by Mg2+ ions and allow continuous influx of Ca2+ ions into cells,
ultimately resulting in neuronal degeneration. Studies suggest that memantine
binds more effectively than Mg2+ ions at the NMDA receptor, and thereby
effectively blocks this prolonged influx of Ca2+ ions through the NMDA channel whilst
preserving the transient physiological activation of the channels by higher
concentrations of synaptically released glutamate. Thus memantine protects
against chronically elevated concentrations of glutamate. Memantine also has
antagonistic activity at the type 3 serotonergic (5-HT3) receptor with a
potency that is similar to that at the NMDA receptor, and lower antagonistic
activity at the nicotinic acetylcholine receptor. This drug has no affinity for
γ-aminobutyric acid (GABA), benzodiazepine, dopamine, adrenergic, histamine, or
glycine receptors or for voltage-dependent calcium, sodium, or potassium
channel.
Reference: Tripathi K.D., “Essentials of
Medical Pharmacology”, Jaypee brothers medical publishers, Seventh edition, New
Delhi, page no. 489,490.
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