Alzheimer's disease medications fact sheet

http://www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm Alzheimer's Disease Medications Fact Sheet Several prescription drugs are currently approved by the U.S. Foodand Drug Administration (FDA) to treat people who have beendiagnosed with Alzheimer’s disease (AD). Treating the symptoms ofAD can provide patients with comfort, dignity, and independence fora longer period of time and can encourage and assist their caregiversas well.
It is important to understand that none of these medications stops thedisease itself.
Medications called cholinesterase inhibitors are prescribed for mild tomoderate AD. These drugs may help delay or prevent symptomsfrom becoming worse for a limited time and may help control somebehavioral symptoms. The medications include: Razadyne®(galantamine), previously known as Reminyl®, Exelon® (rivastigmine), Aricept® (donepezil) andCognex® (tacrine). Cognex® is no longer actively marketed by the manufacturer and is not listedon the chart on the other side of this fact sheet. Scientists do not yet fully understand howcholinesterase inhibitors work to treat AD, but current research indicates that they prevent thebreakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. AsAD progresses, the brain produces less and less acetylcholine; therefore, cholinesterase inhibitorsmay eventually lose their effect.
No published study directly compares these drugs. Because they work in a similar way, it is notexpected that switching from one of these drugs to another will produce significantly differentresults. However, an AD patient may respond better to one drug than another.
A medication known as Namenda® (memantine) is an N-methyl D-aspartate (NMDA) antagonistand is prescribed for the treatment of moderate to severe AD. Studies have shown that the maineffect of Namenda® is to delay progression of some of the symptoms of moderate to severe AD.
The medication may allow patients to maintain certain daily functions a little longer. For example,Namenda® may help a patient in the later stages of AD maintain his or her ability to go to thebathroom independently for several more months, a benefit for both patients and caregivers.
Namenda® is believed to work by regulating glutamate, another important brain chemical that,when produced in excessive amounts, may lead to brain cell death. Because NMDA antagonistswork very differently from cholinesterase inhibitors, the two types of drugs can be prescribed incombination. The FDA has also approved Aricept® for the treatment of moderate to severe AD.
http://www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm Doctors usually start patients at low drug doses and gradually increase the dosage based on howwell a patient tolerates the drug. There is some evidence that certain patients may benefit fromhigher doses of the cholinesterase inhibitor medications. However, the higher the dose, the morelikely are side effects. The recommended effective dosages of the drugs prescribed to treat mild tomoderate, and moderate to severe AD are summarized in the table on the other side.
Patients may be drug‑sensitive in other ways, and they should be monitored when a drug isstarted. Report any unusual symptoms to the prescribing doctor right away. It is important tofollow the doctor’s instructions when taking any medication, including vitamins and herbalsupplements. Also, let the doctor know before adding or changing any medications.
To learn about support groups and publications about AD, contact: Alzheimer’s Disease Education and Referral (ADEAR) CenterP.O. Box 8250Silver Spring, MD 20907-8250 This service of the National Institute on Aging offers information and publications on diagnosis,treatment, patient care, caregiver needs, long-term care, and research.
Alzheimer’s Association225 N. Michigan Avenue, Floor 17Chicago, IL 60601-7633 This non-profit association supports AD research and families and caregivers of patients with AD.
Chapters across the country provide referrals to local resources.
Table - Medications to Treat Alzheimer's Disease Note: The brief summary provided below does not include all information important for patient useand should not be used as a substitute for professional medical advice. Consult the prescribingdoctor and read the package insert before using these or any other medications or supplements.
Drugs are listed in order, as approved by the U.S. Food and Drug Administration, starting with themost recent.
(To view this as one table, please open the PDF version of this publication.) http://www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm and 20 mg/day (10 mg twice aday) at minimum of one weekintervals if well tolerated.
by 3mg/day every 2 weeks to6mg, twice a day (12mg/day) ifwell tolerated; increase patchform to 9.5 mg - patch size 10 cm- once a day after 4 weeks if welltolerated.
including amantadine, an antiviral used to http://www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm treat the flu, dextromethorphan, prescribed to ketamine, sometimes used as an anesthetic, have not been systematically evaluated and should be used with caution in combinationwith this medication.
amitriptyline, fluoxetine, fluvoxamine, and other drugs with anticholinergic action may should be used with caution in combination receptors to releasemore acetylcholine inthe brain.
None observed in laboratory studies; NSAIDs should be used with caution in combination butyrylcholine (a brainchemical similar toacetylcholine) in thebrain.
None observed in laboratory studies; NSAIDs should be used with caution in combination * Use of cholinesterase inhibitors can increase risk of stomach ulcers, and because prolonged useof non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen can also causestomach ulcers, NSAIDs should be used with caution in combination with these medications.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESPublic Health ServiceNational Institutes of HealthNational Institute on Aging http://www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm

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