Several Alzheimer’s prescription drugs are currently approved by the U.S. Food and Drug Administration (FDA) to treat people who have been diagnosed. Learn what these medications do and how they are different.
People with Alzheimer’s disease may take medications to treat the disease itself, behavior changes, and other medical conditions. Caregivers need to know about each medicine the person takes. A doctor or pharmacist can answer questions about medicines.
Questions to Ask
Questions to ask about medicines may include:
- Why is this medicine being used?
- What positive effects should I look for, and when?
- How long will the person need to take it?
- How much should he or she take each day?
- When does the person need to take the medicine?
- What are the side effects?
- Can the medicine be crushed and mixed into foods such as applesauce?
- Can I get the medicine in a liquid form?
- Can this medicine cause problems if taken with other medicines?
People with Alzheimer’s disease often need help taking medicine. If the person lives alone, you may need to call and remind him or her. A pillbox can keep all the pills in one place. As the disease gets worse, you will need to make sure the person takes the medicine, or you will need to give him or her the medicine yourself.
FDA-Approved Medications for Alzheimer’s
Currently, several medicines are approved to treat Alzheimer’s disease: It’s important to understand that none of them can cure or stop the disease. What they can do, for some people, is help them improve for a while from where they started. Most of the time, these medicines work to slow down certain problems, such as memory loss. Slowing down memory loss can allow many people with Alzheimer’s to be more comfortable and independent for a longer time.
The medicines approved to treat Alzheimer’s disease are
- Aricept® (donezepil)—for all stages of Alzheimer’s
- Exelon® (rivastigmine)—for mild to moderate Alzheimer’s
- Razadyne® (galantamine)–for mild to moderate Alzheimer’s
- Namenda® (memantine)—for moderate to severe Alzheimer’s
- Namzarec® (memantine and donepezil)—for moderate to severe Alzheimer’s.
If appropriate, the person’s doctor may prescribe a medicine to treat behavior problems such as anxiety, depression, and aggression. Medicines to treat these behavior problems should be used only after other strategies have been tried. Talk with the doctor about which medicines are safest and most effective.
It is important to understand that none of these medications stops the disease itself.
Medications called cholinesterase inhibitors are prescribed for mild to moderate Alzheimer’s disease. These drugs may help delay or prevent symptoms from becoming worse for a limited time and may help control some behavioral symptoms. The medications include:
- Razadyne® (galantamine)
- Exelon® (rivastigmine)
- Aricept® (donepezil).
Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimer’s disease, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimer’s 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, switching from one of these drugs to another probably will not produce significantly different results. However, an Alzheimer’s patient may respond better to one drug than another.
Memantine currently is an active ingredient in two FDA-approved medications:
A medication known as Namenda® (memantine), an N-methyl D-aspartate (NMDA) antagonist, is prescribed to treat moderate to severe Alzheimer’s disease. This drug’s main effect is to delay progression of some of the symptoms of moderate to severe Alzheimer’s. It may allow patients to maintain certain daily functions a little longer than they would without the medication. For example, Namenda® may help a patient in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both patients and caregivers.
The FDA has also approved Namzaric®, a combination of memantine and donepezil, for the treatment of moderate to severe Alzheimer’s disease.
Namenda® is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work very differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.
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 inhibitors. However, the higher the dose, the more likely are side effects. The recommended effective dosages of drugs prescribed to treat the symptoms of Alzheimer’s and the drugs’ possible side effects are summarized in the table below.
Patients 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 supplements. Also, let the doctor know before adding or changing any medications.
Clinical trials are the best way to find out if promising new treatments are safe and effective in humans. Volunteers are needed for many Alzheimer’s trials conducted around the United States. To learn more, talk with your doctor or visit the ADEAR Center’s listing of clinical trials. More information is available at Volunteer for Alzheimer’s Research and www.ClinicalTrials.gov.
Note: This brief summary 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.
DRUG TYPE AND USE
HOW IT WORKS
COMMON SIDE EFFECTS
|Cholinesterase inhibitor prescribed to treat symptoms of mild, moderate, and severe Alzheimer’s
|Prevents the breakdown of acetylcholine in the brain
|Nausea, vomiting, diarrhea, muscle cramps, fatigue, weight loss
|Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer’s (patch is also for severe Alzheimer’s)
|Prevents the breakdown of acetylcholine and butyrylcholine (a brain chemical similar to acetylcholine) in the brain
|Nausea, vomiting, diarrhea, weight loss, decreased appetite, muscle weakness
|N-methyl D-aspartate (NMDA) antagonist prescribed to treat symptoms of moderate to severe Alzheimer’s
|Blocks the toxic effects associated with excess glutamate and regulates glutamate activation
|Dizziness, headache, diarrhea, constipation, confusion
Namzaric® (memantine extended-release and donepezil)
|NMDA antagonist and cholinesterase inhibitor prescribed to treat symptoms of moderate to severe Alzheimer’s (for patients stabilized on both memantine and donepezil taken separately)
|Blocks the toxic effects associated with excess glutamate and prevents the breakdown of acetylcholine in the brain
|Headache, nausea, vomiting, diarrhea, dizziness, decreased appetite
|Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer’s
|Prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain
|Nausea, vomiting, diarrhea, weight loss, decreased appetite
MANUFACTURER’S RECOMMENDED DOSAGE
For current information about this drug’s safety and use,
|visit www.aricept.com/prescribing-and-patient-info. Click on “Prescribing and Patient Information” to see the drug label.
|visit the www.fda.gov/Drugs. Click on “Drugs @ FDA,” search for Exelon, and click on drug-name links to see “Label Information.”
|visit www.namenda.com . See Full Prescribing Information (PDF, 555K).
Namzaric® (memantine extended-release and donepezil)
|visit www.namzaric.com . Click on “Prescribing Information” to see the drug label.
|visit www.janseenpharmceuticals.com/assets/razadyne_er.pdf to see the drug label.
*Available as a generic drug.
To learn about support groups, research centers, research studies, and publications about Alzheimer’s disease, contact the following resources:
Alzheimer’s Disease Education and Referral (ADEAR) Center
The National Institute on Aging’s ADEAR Center offers information and publications for families, caregivers, and professionals on diagnosis, treatment, patient care, caregiver needs, long-term care, education, training, and research related to Alzheimer’s disease. Staff members answer telephone, email, and written requests and make referrals to local and national resources. Visit the ADEAR website to learn more about Alzheimer’s and other dementias, find clinical trials, and sign up for email updates.
- Alzheimer’s Disease Education and Referral (ADEAR) Center,
A Service of the National Institute on Aging
- National Institutes of Health,
U.S. Department of Health and Human Services
You can order print copies of these publications from the U.S. government’s NIH by calling 1-800-222-2225 or visiting www.nia.nih.gov/health