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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”)