Download Cholinesterase Inhibitors

Caroline Harada, MD
University of Alabama at Birmingham
Cholinesterase Inhibitors
Drug Name
Indications
Benefits
Burdens
Other notes
NMDA Antagonist
Drug Name
Indications
Benefits
Burdens
Other notes
Caroline Harada, MD
University of Alabama at Birmingham
Cholinesterase Inhibitors
Drug Name
Indications
Benefits
Burdens
Other notes
Donepezil (Aricept)
Dementia
(Alzheimer’s,
vascular, Lewy
body), all stages
Modest slowing of
rate of cognitive
decline (delay of 4-6
months functional
decline?)
Can be used safely in combination with memantine
Available only as a pill
Dose is 10mg qhs, 23mg qhs
To minimize side effects, give half the lowest therapeutic dose
for the first month of treatment
Galantamine
(Razadyne)
Dementia
(Alzheimer’s,
vascular, Lewy
body), all stages
Modest slowing of
rate of cognitive
decline (delay of 4-6
months functional
decline?)
Cost
5% nausea (fewer get
diarrhea, vomiting,
abnormal dreams,
tremor, excess
salivation, other side
effects)
Bradycardia is a rare
but serious side effect
Cost
Side effect similar to
donepezil
Rivastigmine
(Exelon)
Dementia
(Alzheimer’s,
vascular, Lewy body,
Parkinson’s), all
stages
Modest slowing of
rate of cognitive
decline (delay of 4-6
months functional
decline?)
Cost
Pill: GI side effects
more common than
the other
cholinesterase
inhibitors
Patch: side effect
profile similar to
donepezil
Can be used safely in combination with memantine
Available for oral or transdermal administration
Dose for pill is 3-6mg BID
Dose for patch is 9.5mg daily
To minimize side effects, give half the lowest therapeutic dose
for the first month of treatment
Can be used safely in combination with memantine
Available only as a pill
Available in once daily dosing (ER formulation) and BID
(generic formulation)
Total daily dose is 16-24mg
To minimize side effects, give half the lowest therapeutic dose
for the first month of treatment
NMDA Antagonist
Drug Name
Indications
Benefits
Burdens
Other notes
Memantine
(Namenda)
Moderate to severe
dementia
Modest slowing of
rate of cognitive
decline
Cost
Minimal side effects
(transient confusion in
first 2 weeks resolves)
Can be used safely in combination with memantine
Available as a pill
Dose is 10mg BID
To minimize side effects, start at one quarter dose for first week,
then slowly titrate up over one month (Can prescribe “Namenda
starter pack”)