During memantine therapy, a patient shows a slight elevation in creatinine clearance. What is the most appropriate action for the provider to consider?

• A. Continue memantine as ordered
• B. Discontinue memantine immediately
• C. Increase memantine dose
• D. Add sodium bicarbonate to urine to alkalinize the urine and increase memantine levels

Answer: (A)

Memantine is cleared by the kidneys, so dosing is guided by renal function. A slight increase in creatinine clearance means the drug will be cleared a bit faster, which does not indicate toxicity or a need to raise the dose. If the patient is tolerating the medication without adverse effects, the best course is to continue the current regimen and monitor renal function over time. Dose adjustments are reserved for when renal function declines (lower creatinine clearance), not when it improves.

Discontinuing the drug would be unnecessary unless there are adverse effects or a specific contraindication. Increasing the dose could raise the risk of CNS-related side effects. Trying to alkalinize urine to raise memantine levels is not a standard or effective strategy and could be unsafe.