Alzheimer's Meds

• What meds are available for Alzheimer's Disease

  Acetylcholinesterase inhibitors (Donepezil, Galantamine, Rivastigmine)

  NMDA receptor antagonist (Memantine)
• Acetylcholinesterase inhibitors

  Donepezil (Aricept), Galantamine, Rivastigmine

  • MOA: inhibit acetylcholinesterase, the enzyme responsible for the destruction of acetylcholine, and improve the availability of acetylcholine
  • AE: n/v/d, anorexia, tremors, bradycardia, muscle cramps
  • CI: Donepezil and galantamine interact with cytochrome P450, caution with Beta blockers, CCB, NSAIDs
  • PtC: donepezil has long half life allowing for once daily dosing, rivastigmine in tablet or 24 hr transdermal patch
• NMDA antagonist: Memantine

  aka Namenda

  • MOA: antagonist w/ low affinity at NMDA receptor, blockade slows the intracellular calcium accumulation and helps prevent further nerve damage AND may prevent excitatory AA neurotoxicity w/o interfering with the physiological actions of glutamate required for memory and learning
  • AE: well tolerated, confusion, agitation, restlessness, constipation, dizziness, headache
  • CI:  caution in seizures or hepatic impairment
  • PtC: dosage adjustment for CrCl <30
  • Clinical use: moderate to severe disease, monotherapy or add to acetylcholinesterase inhibitor