Alzheimer's disease medications: fact sheet.Five prescription drugs prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, currently are approved by the U.S. Food and Drug Administration (FDA FDA abbr. Food and Drug Administration FDA, n.pr See Food and Drug Administration. FDA, n.pr the abbreviation for the Food and Drug Administration. ) to treat people who have been diagnosed with Alzheimer's disease Alzheimer's disease (ăls`hī'mərz, ôls–), degenerative disease of nerve cells in the cerebral cortex that leads to atrophy of the brain and senile dementia. (AD). Treating the symptoms of AD can provide patients with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well. It is important to understand that none of these medications stops the disease itself. Treatment for Mild to Moderate AD Four of these medications are called cholinesterase inhibitors cholinesterase inhibitor n. A drug, such as neostigmine, that restores myoneural function by inhibiting the biodegradation of acetylcholine. Also called acetylcholinesterase inhibitor. , and are prescribed pre·scribe v. pre·scribed, pre·scrib·ing, pre·scribes v.tr. 1. To set down as a rule or guide; enjoin. See Synonyms at dictate. 2. To order the use of (a medicine or other treatment). for mild to moderate AD. These drugs may help delay or prevent symptoms from becoming worse for a limited time and may help control some behavioral symptoms behavioral symptom Neurology In Alzheimer's disease, any of the Sx that relate to action or emotion, such as wandering, depression, anxiety, hostility, sleep disturbances. See Alzheimer's disease. . The medications are: Razadyne[R] (galantamine galantamine /ga·lan·ta·mine/ (gah-lan´tah-men) a reversible competitive inhibitor of acetylcholinesterase used as the hydrobromide salt in the treatment of Alzheimer's disease. , previously known as Reminyl Reminyl® 1 Sabeluzole, see there. 2. Galanthamine [R]), Exelon This article is about the Exelon Corporation. See Exelon (drug) for the Alzheimer's medication. Exelon Corporation (NYSE: EXC) is an electricity generating and distributing company headquartered in Chicago. [R] (rivastigmine rivastigmine /riv·a·stig·mine/ (riv?ah-stig´men) a cholinesterase inhibitor used as the tartrate salt as an adjunct in the treatment of dementia of the Alzheimer type. ), Aricept Ar·i·cept A trademark for the drug donepezil hydrochloride. donepezil hydrochloride Aricept Pharmacologic class: Acetylcholinesterase inhibitor Therapeutic class: [R] (donepezil donepezil /do·nep·e·zil/ (do-nep´e-zil) an acetylcholinesterase inhibitor used as the hydrochloride salt for the treatment of mild to moderate symptoms of dementia of the Alzheimer type; administered orally. ), and Cognex Cog·nex A trademark for the drug tacrine hydrochloride. tacrine hydrochloride Cognex Pharmacologic class: Cholinergic (cholinesterase inhibitor) Therapeutic class: [R] (tacrine tacrine /tac·rine/ (tak´ren) a cholinesterase inhibitor used to improve cognitive performance in dementia of the Alzheimer type; used as the hydrochloride salt. ). Scientists do not yet fully understand how cholinesterase inhibitors work to treat AD, but current research indicates that they prevent the breakdown of acetylcholine acetylcholine (əsēt'əlkō`lēn), a small organic molecule liberated at nerve endings as a neurotransmitter. It is particularly important in the stimulation of muscle tissue. , a brain chemical believed to be important for memory and thinking. As AD progresses, the brain produces less and less acetylcholine; therefore, cholinesterase inhibitors may eventually lose their effect. No published study directly compares these drugs. Because they work in a similar way, it is not expected that switching from one of these drugs to another will produce significantly different results. However, an AD patient may respond better to one drug than another. Cognex[R] is no longer actively marketed. Treatment for Moderate to Severe AD The fifth approved medication, known as Namenda Na·men·da A trademark for the drug memantine hydrochloride. memantine Ebixa (UK), Namenda Pharmacologic class: N-methyl-D-aspartate receptor antagonist (NMDA) Therapeutic class: [R] (memantine memantine Ebixa (UK), Namenda Pharmacologic class: N-methyl-D-aspartate receptor antagonist (NMDA) Therapeutic class: Anti-Alzheimer's agent Pregnancy risk category B Action), is an N-methyl D-aspartate (NMDA NMDAN-methyl-D-asparate ) antagonist antagonist /an·tag·o·nist/ (an-tag´o-nist) 1. a substance that tends to nullify the action of another, as a drug that binds to a cell receptor without eliciting a biological response, blocking binding of substances that could . It is prescribed for the treatment of moderate to severe AD. Studies have shown that the main effect of Namenda[R] is to delay progression of some of the symptoms of moderate to severe AD. The medication may allow patients to maintain certain daily functions a little longer. For example, Namenda[R] may help a patient in the later stages of AD maintain his or her ability to go to the bathroom independently for several more months, a benefit for both patients and caregivers. Namenda[R] is believed to work by regulating glutamate glutamate /glu·ta·mate/ (gloo´tah-mat) a salt of glutamic acid; in biochemistry, the term is often used interchangeably with glutamic acid. glu·ta·mate n. 1. A salt of glutamic acid. , another important brain chemical that, when produced in excessive amounts, may lead to brain cell death. Because NMDA antagonists NMDA antagonist Neurology Any of a number of agents that protect against brain damage in neurologic disorders–eg, stroke; PCP–phencyclidine and ketamine are effective, but have psychotomimetic effects or damage neurons in the cerebral cortex; diazepam work very differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination. The FDA has also approved Aricept[R] for the treatment of moderate to severe AD. Dosage dosage /dos·age/ (do´saj) the determination and regulation of the size, frequency, and number of doses. dos·age n. 1. Administration of a therapeutic agent in prescribed amounts. and Side Effects Side effects Effects of a proposed project on other parts of the firm. Doctors usually start patients at low drug doses and gradually increase the dosage based on how well a patient tolerates the drug. There is some evidence that certain patients may benefit from higher doses of the cholinesterase inhibitor medications. However, the higher the dose, the more likely are side effects. The recommended effective dosage of Namenda[R] is 20 mg/day after the patient has successfully tolerated lower doses. Some additional differences among these medications are summarized in the table on the other side. Patients may be drug-sensitive in other ways, and they should be monitored when a drug is started. Report any unusual symptoms to the prescribing doctor right away. It is important to follow the doctor's instructions when taking any medication, including vitamins and herbal herbal, early botanical book containing descriptions and illustrations of herbs and plants with their properties, chiefly those qualities that made them useful as medicines or condiments. Most of the herbals were written between c.1470 and c. supplements. Also, let the doctor know before adding or changing any medications. For More Information To learn about support groups and publications about AD, contact: Alzheimer's Disease Education and Referral (ADEAR ADEAR Alzheimer's Disease Education And Referral Center ) Center P.O. Box 8250 Silver Spring, MD 20907-8250 1-800-438-4380 Website: www.alzheimers.nia.nih.gov This service of the National Institute on Aging The National Institute on Aging is a division of the U.S. National Institutes of Health, located in Bethesda, Maryland. Formed in 1974, NIA's mission is to improve the health and well-being of older Americans through research. It is the primary U.S. offers information and publications on diagnosis, treatment, patient care, caregiver care·giv·er n. 1. An individual, such as a physician, nurse, or social worker, who assists in the identification, prevention, or treatment of an illness or disability. 2. needs, longterm care, and research. Alzheimer's Association The Alzheimer's Association, incorportated on April 10, 1980 as the Alzheimer’s Disease and Related Disorders Association, Inc., is a non-profit American voluntary health organization which focuses on care, support and research for Alzheimer's disease. 225 N. Michigan Michigan (mĭsh`ĭgən), upper midwestern state of the United States. It consists of two peninsulas thrusting into the Great Lakes and has borders with Ohio and Indiana (S), Wisconsin (W), and the Canadian province of Ontario (N,E). Avenue, Floor 17 Chicago, IL 60601-7633 1-800-272-3900 Website: www.alz.org This non-profit association supports AD research and families and caregivers of patients with AD. Nationwide chapters provide referrals to local resources.
Medications to Treat Alzheimer's Disease
Note: The brief summary provided below does not include all
information important for patient use and should not be used as a
substitute for professional medical advice. Consult the prescribing
doctor and read the package insert before using these or any other
medications or supplements. Drugs are listed in order, as approved
by the U.S. Food and Drug Administration, starting with the most
recent.
DRUG NAME DRUG TYPE AND
TREATMENT
Namenda[R] (memantine) N-methyl D-aspartate (NMDA)
Blocks the toxic effects associated antagonist prescribed to treat
with excess glutamate and regulates symptoms of moderate to severe
glutamate activation. AD
Razadyne[R] (galantamine, formerly Cholinesterase inhibitor
known as Reminyl[R]) prescribed to treat symptoms
Prevents the breakdown of of mild to moderate AD
acetylcholine and stimulates
nicotinic receptors to release more
acetylcholine in the brain.
Exelon[R] (rivastigmine) Cholinesterase inhibitor
Prevents the breakdown of prescribed to treat symptoms
acetylcholine and butyrylcholine (a of mild to moderate AD
brain chemical similar to
acetylcholine) in the brain.
Aricept[R] (donepezil) Cholinesterase inhibitor
Prevents the breakdown of prescribed to treat symptoms
acetylcholine in the brain. of mild to moderate, and
moderate to severe AD
Cognex[R] (tacrine) Cholinesterase inhibitor
Prevents the breakdown of prescribed to treat symptoms
acetylcholine in the brain. Note: of mild to moderate AD
Cognex is still available but no
longer actively marketed by the
manufacturer.
DRUG NAME MANUFACTURER'S RECOMMENDED
DOSAGE
Namenda[R] (memantine) * 5 mg, once a day, available
Blocks the toxic effects associated in tablet form
with excess glutamate and regulates * Increase to 10 mg/day (5 mg
glutamate activation. twice a day), 15 mg/day (5
mg and 10 mg as separate
doses), and 20 mg/day (10 mg
twice a day) at minimum of
one week intervals if well
tolerated.
Razadyne[R] (galantamine, formerly * 4mg, twice a day (8mg/day),
known as Reminyl[R]) available in tablet or
Prevents the breakdown of capsule form
acetylcholine and stimulates * Increase by 8mg/day after 4
nicotinic receptors to release more weeks to 8mg, twice a day
acetylcholine in the brain. (16mg/day) if well
tolerated.
* After another 4 weeks,
increase to 12mg, twice a
day (24mg/day) if well
tolerated.
Exelon[R] (rivastigmine) * 1.5mg, twice a day (3mg/
Prevents the breakdown of day), available in capsule
acetylcholine and butyrylcholine (a and liquid form
brain chemical similar to * Increase by 3mg/day every 2
acetylcholine) in the brain. weeks to 6mg, twice a day
(12mg/day) if well
tolerated.
Aricept[R] (donepezil) * 5mg, once a day, available
Prevents the breakdown of in tablet form
acetylcholine in the brain. * Increase after 4-6 weeks to
10mg, once a day if well
tolerated.
Cognex[R] (tacrine) * 10mg, four times a day
Prevents the breakdown of (40mg/day), in capsule form
acetylcholine in the brain. Note:
Cognex is still available but no * Increase by 40mg/day every 4
longer actively marketed by the weeks to 40mg, four times a
manufacturer. day (160mg/day), if liver
enzyme functions remain
normal and if well
tolerated.
DRUG NAME COMMON SIDE
EFFECTS
Namenda[R] (memantine) Dizziness, headache,
Blocks the toxic effects associated constipation,
with excess glutamate and regulates confusion
glutamate activation.
Razadyne[R] (galantamine, formerly Nausea, vomiting,
known as Reminyl[R]) diarrhea, weight loss
Prevents the breakdown of
acetylcholine and stimulates
nicotinic receptors to release more
acetylcholine in the brain.
Exelon[R] (rivastigmine) Nausea, vomiting,
Prevents the breakdown of weight loss, upset
acetylcholine and butyrylcholine (a stomach, muscle
brain chemical similar to weakness
acetylcholine) in the brain.
Aricept[R] (donepezil) Nausea, diarrhea,
Prevents the breakdown of vomiting
acetylcholine in the brain.
Cognex[R] (tacrine) Nausea, diarrhea,
Prevents the breakdown of possible liver CE
acetylcholine in the brain. Note: damage
Cognex is still available but no
longer actively marketed by the
manufacturer.
DRUG NAME POSSIBLE DRUG
INTERACTIONS
Namenda[R] (memantine) Other NMDA antagonist
Blocks the toxic effects associated medications, including
with excess glutamate and regulates amantadine, an antiviral used
glutamate activation. to treat the flu,
dextromethorphan, prescribed
to relieve coughs due to colds
or flu, and ketamine,
sometimes used as an
anesthetic, have not been
systematically evaluated and
should be used with caution in
combination with this
medication.
Razadyne[R] (galantamine, formerly Some antidepressants such as
known as Reminyl[R]) paroxetine, amitriptyline,
Prevents the breakdown of fluoxetine, fluvoxamine, and
acetylcholine and stimulates other drugs with
nicotinic receptors to release more anticholinergic action may
acetylcholine in the brain. cause retention of excess
Reminyl in the body, leading
to complications; NSAIDs
should be used with caution in
combination with this
medication. *
Exelon[R] (rivastigmine) None observed in laboratory
Prevents the breakdown of studies; NSAIDs should be used
acetylcholine and butyrylcholine (a with caution in combination
brain chemical similar to with this medication.*
acetylcholine) in the brain.
Aricept[R] (donepezil) None observed in laboratory
Prevents the breakdown of studies; NSAIDs should be used
acetylcholine in the brain. with caution in combination
with this medication. *
Cognex[R] (tacrine) NSAIDs should be used with
Prevents the breakdown of caution in combination with
acetylcholine in the brain. Note: this medication. *
Cognex is still available but no
longer actively marketed by the
manufacturer.
* Use of cholinesterase inhibitors can increase risk of stomach
ulcers, and because prolonged use of non-steroidal anti-inflammatory
drugs (NSAIDs) such as aspirin or ibuprofen can also cause stomach
ulcers, NSAIDs should be used with caution in combination with these
medications.
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