From the Guidelines
The most effective medications for treating Alzheimer's disease are cholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine, and memantine, which can help manage symptoms and slow disease progression. According to the most recent study 1, the goal of treatment in dementia is to delay clinical decline, benefit cognitive function, and help reduce symptoms such as memory loss and confusion. Cholinesterase inhibitors are generally recommended for mild to moderate dementia, while memantine is recommended for severe dementia. The combination of memantine and donepezil is also recommended for severe Alzheimer's disease.
Medication Options
- Cholinesterase inhibitors:
- Donepezil (Aricept) at 5-10mg daily
- Rivastigmine (Exelon) at 1.5-6mg twice daily or as a 4.6-13.3mg/24hr patch
- Galantamine (Razadyne) at 4-12mg twice daily
- Memantine (Namenda) at 5-10mg twice daily
- Combination therapy with donepezil and memantine (Namzaric)
Treatment Considerations
- Treatment should start early after diagnosis and requires regular monitoring for side effects, which commonly include nausea, vomiting, diarrhea, and dizziness 1.
- Medication effectiveness varies by individual, and they work best alongside non-drug approaches like cognitive stimulation and lifestyle modifications.
- Newer treatments, such as aducanumab (Aduhelm) and lecanemab (Leqembi), which target amyloid plaques in the brain, have limited availability and significant side effects, including brain swelling.
Clinical Guidelines
- The American College of Physicians and the American Academy of Family Physicians recommend basing the choice of pharmacologic agents on tolerability, adverse effect profile, ease of use, and cost of medication 1.
- The UK, US, China, and Japan have clinical pharmacotherapy guidelines that recommend cholinesterase inhibitors for mild to moderate dementia and memantine for severe dementia 1.
From the FDA Drug Label
Donepezil hydrochloride tablets are a prescription medicine to treat mild, moderate, and severe Alzheimer’s disease. Donepezil hydrochloride tablets can help with mental function and with doing daily tasks.
Medications that treat Alzheimer's disease:
- Donepezil hydrochloride tablets These tablets are used to treat mild, moderate, and severe Alzheimer’s disease, and can help with mental function and daily tasks. 2 2
From the Research
Medications for Alzheimer's Disease
The following medications are used to treat Alzheimer's disease:
- Cholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine, which have been shown to improve cognition, function, and behavior in patients with mild to moderate Alzheimer's disease 3, 4, 5
- N-methyl D-aspartate receptor antagonist, such as memantine, which is used in combination with cholinesterase inhibitors to treat moderate to severe Alzheimer's disease 6, 7
- Aducanumab, a newer medication that has been shown to reduce the accumulation of amyloid-beta and slow the progression of cognitive and memory impairment 6
Mechanism of Action
These medications work by:
- Inhibiting the breakdown of acetylcholine, a neurotransmitter associated with memory, which helps to improve cognitive function 3, 5
- Reducing the accumulation of amyloid-beta, a protein that contributes to the development of Alzheimer's disease 6
- Affecting N-methyl D-aspartate (NMDA) receptors, which helps to reduce glutamate and increase acetylcholine levels in the brain 6
Efficacy and Safety
Studies have shown that these medications can:
- Improve cognitive function, global functioning, and activities of daily living in patients with mild to moderate Alzheimer's disease 3, 4, 5
- Delay nursing home admission and slow the rate of cognitive and functional impairment in patients with Alzheimer's disease 7
- Have a modest but significant therapeutic benefit in the treatment of Alzheimer's disease, despite higher rates of treatment discontinuation and side effects than placebo 4, 5
- Have side effects, such as nausea, vomiting, diarrhea, and sleep disturbances, which can be dose-related and most problematic during dose titration 4, 5