Drugs for Alzheimer’s disease How and where can you get the drugs?
The drugs that are currently available are not a cure and do not stop the
The drugs are available on NHS prescription from
progression of the disease. They may, however, temporarily ease some
approved hospital specialists according to strict
of the symptoms of Alzheimer’s disease in some people.
criteria. Treatment cannot be initiated by
general practitioners. There is no known way to
predict whether or not an individual with Alzheimer’s disease will benefit. It is important
The drugs available on prescription are:- rivastigmine (‘Exelon’)
to have a thorough discussion about the possible
advantages and disadvantages of treatment
before the drug is started. Following an initial
How do they work?
trial period, the drug will only be continued if
Acetylcholine is a natural brain chemical that allows the brain to function efficiently. In Alzheimer’s
there is clear evidence of benefit. You will then
disease, there is not enough acetylcholine. Donepezil, rivastigmine and galantamine slow the breakdown
be monitored to ensure that it is appropriate to
of acetylcholine by blocking the action of an enzyme in the brain called cholinesterase. This allows higher
concentrations of acetylcholine to stay in the brain. Memantine regulates another chemical in the brain
NICE Guidelines on use of Donepezil,
called glutamate; this can damage nerve cells if levels are too high. Memantine seems to have a
Rivastigmine, Galantamine and Memantine for Alzheimer’s disease. Potential benefits and side effects
• Donepezil, galantamine and rivastigmine are recommended as options for managing mild to
Not all patients respond to the drugs. Those that do may find they are more able to concentrate and they
moderate Alzheimer’s disease.
may experience an improvement with their memory. Over time, the benefits seen may decline. As with
any drug, some patients may experience side effects, though these are not common. Those occasionally
• Memantine is recommended as an option for managing moderate Alzheimer’s disease and for people who
reported include diarrhoea, nausea, muscle cramps, vivid dreams and loss of appetite. In most cases,
cannot take one of the other three drugs, or who have
these side effects are mild, usually lasting a few days after the drug is first started. If side effects are more
severe Alzheimer’s disease.
troublesome it may be possible to stop them by taking the drug with meals, taking at a different time of
• Diagnosis of Alzheimer’s disease, baseline assessment
day or taking a lower dose. Occasionally it may be necessary to stop the drug.
and initiation of treatment should be made by a specialist clinic. Are the drugs suitable for all patients? • Drug treatment should be continued only when it is
Donepezil, rivastigmine and galantamine are for the treatment of mild to moderate Alzheimer’s disease.
considered to be having a worthwhile effect on
Memantine may help some patients with more severe dementia. Because of the declining number of
functioning nerve cells present in the brain as the disease progresses, the drugs may be less effective for
• Patients who continue on treatment should be reviewed
individuals in the more advanced stages of the disease. The drugs may not be advised in patients with
regularly and carers’ views on the patient’s condition
certain heart conditions, peptic ulcer, asthma, seizures or in patients taking certain other drugs.
and response to treatment should be sought. DONEPEZIL (‘ARICEPT’) is administered
once daily, initially at a dose of 5mg daily.
This may be increased to 10mg daily later, as
determined by your doctor. It is usually taken
before bedtime, but if more convenient can
RIVASTIGMINE (‘EXELON’) Drugs for
(changed once daily). The initial dose of the
capsules is 1.5mg twice daily. This increases
at about 4 week intervals to 3mg twice daily,
tolerated well. The effective dose is between
3mg to 6mg twice daily. If side effects occur,
they sometimes respond to omitting one or
two doses or the daily dose may be reduced.
The initial dose of the skin patch is 4.5mg. A
higher 9.5mg patch may be tried after a few
GALANTAMINE (‘REMINYL-XL’) is taken
starting dose is 8mgs daily. This increases
after 4 weeks to the initial maintenance dose
of 16mgs daily. After at least a further 4
Academic Centre, University Hospital Llandough, Penarth,
weeks, this may sometimes be increased to
Tel No. 029 20716961, Fax No. 029 20704244
24mgs daily after appropriate assessment.
MEMANTINE (‘EBIXA’) is administered http://medicine.cf.ac.uk/en/departments/medicine/geriatric- medicine/memory-team/
increasing in steps of 5mg at weekly intervals
April 2011 TÎM Y COF CAERDYDD
The American Journal of Medicine (2006) 119, e3-e5 CLINICAL COMMUNICATION TO THE EDITOR Rituximab-induced Elimination of Acquired frequent administration of C1-inhibitor concentrate, leading Angioedema Due to C1-Inhibitor Deficiency to very frequent attacks of severe These at-tacks may be life-threatening and obviously have a majorimpact on morbidity and quality of life. Here we descr
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