What are the medications for Alzheimer's disease?

From the Guidelines

Medications for Alzheimer's disease should be chosen based on tolerability, adverse effect profile, ease of use, and cost of medication, with cholinesterase inhibitors and memantine being options for improving symptoms in cognition and global function. When considering treatment for Alzheimer's disease, it's essential to weigh the benefits and risks of each medication. Cholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine, are typically prescribed in early to moderate stages, starting with low doses that gradually increase 1. These medications work by preventing the breakdown of acetylcholine, a brain chemical important for memory and thinking. Memantine, often prescribed for moderate to severe Alzheimer's, works differently by regulating glutamate activity and is typically started at 5mg daily, gradually increasing to 10mg twice daily 1.

Some key points to consider when selecting a medication for Alzheimer's disease include:

• The evidence is insufficient to compare the effectiveness of different pharmacologic agents for the treatment of dementia 1
• Cholinesterase inhibitors and memantine can improve symptoms, primarily in the domains of cognition and global function 1
• Clinically important differences were not consistently evaluated or demonstrated in these 2 domains for all drugs 1
• Direct comparisons among these drugs are limited and do not suggest important differences 1
• Major contraindications of cholinesterase inhibitors and memantine include, but are not limited to, uncontrolled asthma, angle-closure glaucoma, the sick sinus syndrome, and left bundle-branch block 1

Regular follow-up with healthcare providers is essential to monitor effectiveness and adjust treatment as the disease progresses. Common side effects of these medications include nausea, vomiting, diarrhea, and sleep disturbances. The choice of pharmacologic agent should be based on individual patient factors, such as tolerability, adverse effect profile, ease of use, and cost of medication 1.

From the FDA Drug Label

The effectiveness of donepezil hydrochloride in the treatment of patients with moderate to severe Alzheimer’s disease was established in studies employing doses of 10 mg/day and 23 mg/day The effectiveness of galantamine in the treatment of Alzheimer's disease is demonstrated by the results of two Phase 3 studies

Medications for Alzheimer's Disease:

• Donepezil: Effective in the treatment of patients with moderate to severe Alzheimer’s disease, with established doses of 10 mg/day and 23 mg/day 2
• Galantamine: Demonstrated effectiveness in the treatment of Alzheimer's disease in two Phase 3 studies 3

From the Research

Medication for Alzheimer's Disease

• The current recommended standard of care for the symptomatic treatment of mild to moderate Alzheimer's disease is cholinesterase inhibitors, including donepezil, rivastigmine, and galantamine 4.
• These medications have demonstrated efficacy in improving cognition, function, and behavior in patients with Alzheimer's disease, but their benefits are not sustained indefinitely and the illness continues to progress 4.
• Donepezil, in particular, has been shown to improve cognition and global clinical function in patients with mild to moderate Alzheimer's disease, with beneficial effects on activities of daily living and a significant reduction in caregiver burden 5.

Cholinesterase Inhibitors

• Cholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine, appear to show modest but statistically significant improvements on several measures, including cognition and global functioning 6.
• The use of cholinesterase inhibitors across all stages of Alzheimer's disease is recommended, with early initiation and persistent exposure leading to delays in nursing home admission and slower rates of cognitive and functional impairment 6.
• Higher dose cholinesterase inhibitors, such as donepezil 23 mg/day, may be beneficial for patients with moderate to severe Alzheimer's disease, particularly for language and visuospatial ability 7.

Benefits and Risks

• Cholinesterase inhibitors have proven efficacy in improving cognition, behavior, activities of daily living, and global functioning in mild-to-moderate Alzheimer's disease, and have also been shown to reduce caregiver stress and delay time to nursing home placement 8.
• However, cholinesterase inhibitors are associated with side effects, including gastrointestinal, cardiorespiratory, extrapyramidal, genitourinary, and musculoskeletal symptoms, as well as sleep disturbances, which can be dose-related and most problematic during dose titration 8.
• The benefits and risks of cholinesterase inhibitor therapy should be carefully considered, and patients should be regularly monitored for any potential serious side effects 6, 8.