Acetylcholinesterase inhibitors

• Examples:

  • Donepezil
  • Rivastigmine
  • Galantamine
• MOA:

  • Prevent acetylcholinesterase from breaking down neurotransmitter acetylcholine - patients with dementia have a deficit
  • Donepezil is a reversible acetylcholinesterase inhibitor
• Indication:

  • Mild to moderate Alzheimer's disease
  • Can be used in other dementias if evidence it is mixed
• Cautions:

  • Asthma and COPD
  • Cardiac disease
  • History of ulcers e.g. peptic ulcers
  • Concomitant use of antipsychotics - increased risk of neuroleptic malignant syndrome
  • History of seizures
  • Galantamine should be used with caution in GI obstruction
• Routes:

  • PO
  • Topical - patches
• Common side effects:

  • GI disturbance
  • Muscle cramps
  • Headache
  • Dizziness
  • Rash
  • Syncope
  • Agitation
  • Hallucinations
  • Neuroleptic malignant syndrome