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What medicines are used to treat Alzheimer's disease?

While the complexity of Alzheimer’s disease makes it difficult to delay, prevent, cure or reverse the disease, treatments and medications can help people maintain their mental function and temporarily stabilize or slow progression of the disease. Several drugs are approved by the U.S. Food and Drug Administration (FDA) to treat Alzheimer’s. Donepezil (Aricept), rivastigimine (Exelon) and galantamine (Razadyne) are used to treat mild to moderate Alzheimer’s. They are known as cholinesterase inhibitors and work by increasing the amount of the neurotransmitter acetylcholine in the brain. Acetylcholine helps brain cells communicate.

Donepezil, along with memantine (Namenda), may be used to treat moderate to severe Alzheimer’s. Memantine works on a different neurotransmitter called glutamate. Because all of the drugs work in similar ways, switching from one to another usually doesn’t provide significantly different results, but some people may respond better to one drug than another.

Although no cure for Alzheimer's disease (AD) exists, a number of medications may help delay symptom progression. Medication also may temporarily help boost cognitive function and improve a person's ability to perform daily activities. The two main classes of AD medications are cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists.

Cholinesterase inhibitors help prevent the breakdown of acetylcholine, a neurotransmitter involved in memory and thinking. These medications are generally prescribed for mild to moderate cases of AD. Examples include donepezil, galantamine, and rivastigmine. Side effects associated with this class of medication may include upset stomach, nausea, vomiting, diarrhea, headache, dizziness, change in appetite, sleep disturbance, muscle weakness, and weight loss. These medications also may increase the risk of stomach irritation and ulcers.

N-methyl-D-aspartate (NMDA) receptor antagonists help regulate glutamate, a neurotransmitter necessary for learning and memory. Currently, the only Food and Drug Administration (FDA)-approved NMDA for treating AD is called memantine, which is used to treat moderate to severe cases of the disease. Side effects of this medication may include headache, dizziness, vomiting, cough, back pain, confusion, constipation, and sleepiness.

 

Stacy Wiegman, PharmD
Pharmacy Specialist

Some doctors find that combining different Alzheimer's drugs increases the benefits in some patients. For example, memantine is often prescribed together with donepezil (Aricept)—another treatment for Alzheimer's disease that works on another pathway in the brain—and studies have shown that Namenda may be more effective when combined with another Alzheimer's drug called a cholinesterase inhibitor.

However, when drugs are combined, the interactions can be unpredictable. For example, combining memantine with another NMDA antagonist such as amantadine or dextromethorphan (found in many over-the-counter cough suppressants) could cause a negative reaction because they work similarly.

Any time you take prescriptions from multiple doctors it is a good idea to let each doctor know all the medications, supplements and over-the-counter remedies you are taking so you can be monitored carefully for interactions. Filling all your prescriptions at the same pharmacy can allow the pharmacist to detect potentially dangerous combinations.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.