{
 "query": "donepezil / memantine",
 "ingredient": "donepezil / memantine",
 "slug": "donepezil-memantine",
 "rxcui": "1430990",
 "brands": [
  "Namzaric"
 ],
 "names": [
  "donepezil / memantine"
 ],
 "components": [
  {
   "ingredient": "donepezil",
   "slug": "donepezil",
   "grade": "B",
   "total": 85,
   "scores": {
    "safety": "B",
    "evidence": "D",
    "regulatory": "A",
    "conflict": "A",
    "options": "A"
   },
   "boxed": false,
   "controlled": false,
   "first_approval_fmt": "11/25/1996",
   "first_approval": "19961125"
  },
  {
   "ingredient": "memantine",
   "slug": "memantine",
   "grade": "B",
   "total": 83,
   "scores": {
    "safety": "B",
    "evidence": "C",
    "regulatory": "A",
    "conflict": "A",
    "options": "C"
   },
   "boxed": false,
   "controlled": false,
   "first_approval_fmt": "10/16/2003",
   "first_approval": "20031016"
  }
 ],
 "classes": [],
 "alternatives": [],
 "label": {},
 "faers": null,
 "faers_base": {
  "total": 20692304,
  "serious_share": 0.5742697381596559,
  "death_share": 0.09102355155810585
 },
 "recalls": [],
 "recall_total": 0,
 "drugsfda": {
  "first_approval": "19961125",
  "first_approval_fmt": "",
  "anda": 43,
  "nda": 0,
  "rems": false,
  "labeling_recent": 0
 },
 "trials": null,
 "pubmed": null,
 "payments": {
  "year": "2024",
  "usd": 0.0,
  "records": 0,
  "by_name": [],
  "names_checked": [
   "donepezil / memantine",
   "Namzaric"
  ],
  "source": "bulk-index"
 },
 "partd": {
  "year": "2024",
  "claims": 129758,
  "beneficiaries": 18217,
  "spend": 89617221.8,
  "by_brand": [
   {
    "brand": "Namzaric",
    "claims": 129758,
    "per_claim": 690.64891413,
    "is_generic": false
   }
  ],
  "per_claim": 690.648914132462
 },
 "mdl": [],
 "dsc": [],
 "settlements": [],
 "prescrire": null,
 "eml": null,
 "exposure": null,
 "scores": {
  "safety": {
   "score": 82,
   "letter": "B",
   "why": [
    "Graded by its riskiest ingredient, memantine (82)",
    "Listed by the independent review Prescrire as a drug to avoid (2026 edition) (-10)",
    "651 FDA reports naming it as the suspect drug per million Medicare fills, 0.2x the median drug on this site",
    "Death appears in 1.7x the share of reports seen across all of FAERS (-3)",
    "Off-label use is among the five most-reported items: widely used beyond its approved evidence (-5)"
   ],
   "weight": 0.35
  },
  "evidence": {
   "score": 61,
   "letter": "D",
   "why": [
    "Graded by its riskiest ingredient, donepezil (61)",
    "294 randomized trials and 52 systematic reviews/meta-analyses indexed in PubMed",
    "Prescrire's independent reviewers find its harm-benefit balance unfavourable versus alternatives (-10)",
    "8 independent Cochrane review(s) exist",
    "Only 39% of completed registered trials posted results (-8)"
   ],
   "weight": 0.25
  },
  "regulatory": {
   "score": 97,
   "letter": "A",
   "why": [
    "Graded by its riskiest ingredient, donepezil (97)",
    "Recalls since 2016: 0 Class I, 2 Class II, 0 Class III across 47 generic makers (-3)"
   ],
   "weight": 0.15
  },
  "conflict": {
   "score": 100,
   "letter": "A",
   "why": [
    "Graded by its riskiest ingredient, donepezil (100)",
    "Pharma paid doctors $0 tied to this drug last year: negligible",
    "Not named in any pending federal MDL"
   ],
   "weight": 0.15
  },
  "options": {
   "score": 70,
   "letter": "C",
   "why": [
    "Graded by its riskiest ingredient, memantine (70)",
    "Generic versions approved (43 applications)",
    "No same-class alternatives found: little leverage to switch (-30)"
   ],
   "weight": 0.1
  }
 },
 "total": 80,
 "grade": "B",
 "questions": [
  "This is a fixed combination of donepezil and memantine. Why both together, instead of only the one I need?",
  "An independent reviewer (Prescrire) lists this as a drug to avoid because the harms outweigh the benefits versus alternatives. What is your view on that?",
  "The most-reported problems in FDA's adverse event data are fall, death, diarrhoea, fatigue. How would we recognize and handle those?",
  "Why this one over benzgalantamine, galantamine, rivastigmine? What would make you pick one of those instead?",
  "What result are we expecting, by when, and what is the plan if it does not happen?",
  "If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)",
  "The most-reported problems in FDA's adverse event data are fall, death. How would we recognize and handle those?",
  "Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?"
 ]
}