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Making the most of your visit with the healthcare provider

Use this tool to report changes in your loved one's Alzheimer's symptoms to their healthcare provider—to help them determine an appropriate treatment plan for your loved one

This tool is a resource for caregivers. The tool and the final report are not intended to suggest that any treatment for Alzheimer's disease, including NAMZARIC^® (memantine HCl and donepezil HCl), may provide a benefit to any of the specific symptoms presented or identified.

For each symptom, use the drop-down lists to select whether or not this is a new symptom (Yes or No) and how frequently you've noticed this symptom since your loved one's last appointment:

Loss of memory of recent events/confusion

Problems with spoken/written communication

Getting lost/losing things

Difficulty managing personal finances (paying bills)

Difficulty with household tasks and using common household devices (laundry, making meals, microwave)

Problems with personal care (getting dressed, bathing, grooming, toileting)

Loss of interest/withdrawal

Thinking about your loved one over the past month, please list your top concerns that you would like the healthcare provider to be aware of:

Questions to ask about treatment with once-daily NAMZARIC:

Below are some questions you may want to ask your loved one’s healthcare provider at the next appointment:

Does my loved one have moderate or severe Alzheimer's?
I recently learned about NAMZARIC, do you think it could be right for my loved one?
What are possible side effects of NAMZARIC?
What should I expect to see after my loved one starts treatment with NAMZARIC?

Please answer the questions above in red.

NAMZARIC is a prescription medicine approved to treat moderate to severe Alzheimer’s disease in patients who are taking donepezil hydrochloride 10 mg, the active ingredient in Aricept^®.

There is no evidence that NAMZARIC prevents or slows the underlying disease process in patients with Alzheimer's disease.

Important Risk Information

NAMZARIC should not be taken by anyone who: has an allergy to memantine HCl, donepezil HCl, medicines that contain piperidines, or any of the ingredients in NAMZARIC.

Before taking NAMZARIC, tell the doctor about all of the patient’s medical conditions, including:

heart problems including an irregular, slow, or fast heartbeat
asthma or lung problems
seizures
stomach ulcers
bladder, kidney, or liver problems
any surgical, dental, or other medical procedures scheduled when anesthesia may be used

Tell the doctor about all the medicines the patient takes, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

What are the possible side effects of NAMZARIC?

NAMZARIC may cause serious side effects, including:

muscle problems in patients given anesthesia
slow heartbeat and fainting. This happens more often in people with heart problems. Call the doctor right away if the patient faints while taking NAMZARIC.
more stomach acid. This raises the chance of ulcers and bleeding especially when taking NAMZARIC. The risk is higher for patients who have had ulcers, or take aspirin or other NSAIDs.
nausea and vomiting
difficulty passing urine
seizures
worsening of lung problems in people with asthma or other lung disease

The most common side effects of memantine HCl include: headache, diarrhea, and dizziness.

The most common side effects of donepezil HCl include: diarrhea, not wanting to eat (anorexia), and bruising.

These are not all the possible side effects of NAMZARIC.

Please see full Prescribing Information, including Patient Information.

Aricept^® is a registered trademark used by Eisai Inc. under license from Eisai R&D Management Co., Ltd.

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NAMZARIC is a prescription medicine approved to treat moderate to severe Alzheimer’s disease in patients who are taking donepezil hydrochloride 10 mg, the active ingredient in Aricept^®.

There is no evidence that NAMZARIC prevents or slows the underlying disease process in patients with Alzheimer's disease.

NAMZARIC is a prescription medicine approved to treat moderate to severe Alzheimer’s disease in patients who are taking donepezil hydrochloride 10 mg, the active ingredient in Aricept^®.

There is no evidence that NAMZARIC prevents or slows the underlying disease process in patients with Alzheimer's disease.

Important Risk Information

NAMZARIC should not be taken by anyone who: has an allergy to memantine HCl, donepezil HCl, medicines that contain piperidines, or any of the ingredients in NAMZARIC.

Before taking NAMZARIC, tell the doctor about all of the patient’s medical conditions, including:

heart problems including an irregular, slow, or fast heartbeat
asthma or lung problems
seizures
stomach ulcers
bladder, kidney, or liver problems
any surgical, dental, or other medical procedures scheduled when anesthesia may be used

Tell the doctor about all the medicines the patient takes, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

What are the possible side effects of NAMZARIC?

NAMZARIC may cause serious side effects, including:

muscle problems in patients given anesthesia
slow heartbeat and fainting. This happens more often in people with heart problems. Call the doctor right away if the patient faints while taking NAMZARIC.
more stomach acid. This raises the chance of ulcers and bleeding especially when taking NAMZARIC. The risk is higher for patients who have had ulcers, or take aspirin or other NSAIDs.
nausea and vomiting
difficulty passing urine
seizures
worsening of lung problems in people with asthma or other lung disease

The most common side effects of memantine HCl include: headache, diarrhea, and dizziness.

The most common side effects of donepezil HCl include: diarrhea, not wanting to eat (anorexia), and bruising.

These are not all the possible side effects of NAMZARIC.

Indication

NAMZARIC is a prescription medicine approved to treat moderate to severe Alzheimer’s disease in patients who are taking donepezil hydrochloride 10 mg, the active ingredient in Aricept^®.

Please see full Prescribing Information, including Patient Information.

Aricept^® is a registered trademark used by Eisai Inc. under license from Eisai R&D Management Co., Ltd.