When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to memantine, donepezil, or medicines that contain piperidine.

How to Use This Medicine:
Delayed Release Capsule

• Your doctor will tell you how much medicine to use. Do not use more than directed. This medicine should be taken at bedtime.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Swallow the capsule whole. Do not crush, divide, or chew it.
• If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of soft food such as pudding, yogurt, or applesauce. Stir this mixture well and swallow it without chewing.
• Missed dose: Skip the missed dose and take your next dose at the regular time. Do not take extra medicine to make up for a missed dose.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some foods and medicines can affect how memantine/donepezil works. Tell your doctor if you are using any of the following:
  
  • Amantadine, bethanechol, carbamazepine, dexamethasone, dextromethorphan, ketoconazole, phenobarbital, phenytoin, quinidine, rifampin, or sodium bicarbonate
  • NSAID pain or arthritis medicine (such as aspirin, diclofenac, ibuprofen, naproxen)

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, heart disease, stomach ulcers or bleeding, trouble urinating, or a history of asthma or lung or breathing problems.
• This medicine may cause the following problems:
  
  • Stomach or bowel bleeding
  • Seizures
• Tell any doctor or dentist who treats you that you are using this medicine. You may need to stop using this medicine several days before you have surgery or medical tests.
• Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, red skin rash
• Bloody or black, tarry stools
• Chest pain, fainting, trouble breathing
• Decrease in how much or how often you urinate
• Slow, fast, or uneven heartbeat
• Seizures
• Vomiting blood or material that looks like coffee grounds, severe stomach pain

If you notice these less serious side effects, talk with your doctor:

• Diarrhea, nausea, vomiting
• Loss of appetite, weight loss

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088