Sunday, July 10

Alzheimer's Drugs: What You Need to Know

FACT SHEET:

Several prescription drugs are currently approved by the U.S. Food and Drug Administration (FDA) to treat people who have been diagnosed with Alzheimer's. Learn what they do and how they are different.


Dementia Medications

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:

  1. Why is this medicine being used?
  2. What positive effects should I look for, and when?
  3. How long will the person need to take it?
  4. How much should he or she take each day?
  5. When does the person need to take the medicine?
  6. What are the side effects?
  7. Can the medicine be crushed and mixed into foods such as applesauce?
  8. Can I get the medicine in a liquid form?
  9. 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

  1. Aricept® (donezepil)—for all stages of Alzheimer’s
  2. Exelon® (rivastigmine)—for mild to moderate Alzheimer’s
  3. Razadyne® (galantamine)--for mild to moderate Alzheimer’s
  4. Namenda® (memantine)—for moderate to severe Alzheimer’s
  5. 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.

Cholinesterase Inhibitors Treat Mild-to-Moderate Alzheimer's

Treating the symptoms of Alzheimer's can provide patients with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well.

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:

  1. Razadyne® (galantamine)
  2. Exelon® (rivastigmine)
  3. 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 Treats Moderate-to-Severe Alzheimer's

Memantine currently is an active ingredient in two FDA-approved medications:

  1. Namenda®
  2. Namzaric®

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.

Dosage and Side Effects

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.

Testing New Alzheimer's Drugs

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.

Charts of Alzheimer's Drugs

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 NAME

DRUG TYPE AND USE

HOW IT WORKS

COMMON SIDE EFFECTS

Aricept® (donepezil)
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
Exelon® (rivastigmine)
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
Namenda® (memantine)
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
Razadyne® (galantamine)
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


DRUG NAME

MANUFACTURER’S RECOMMENDED DOSAGE

FOR MORE INFORMATION

Aricept® (donepezil)
  • Tablet*: Initial dose of 5 mg once a day
  • May increase dose to 10 mg/day after 4-6 weeks if well tolerated, then to 23 mg/day after at least 3 months
  • Orally disintegrating tablet*: Same dosage as above
  • 23-mg dose available as brand-name tablet only
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.
Exelon® (rivastigmine)
  • Capsule*: Initial dose of 3 mg/day (1.5 mg twice a day)
  • May increase dose to 6 mg/day (3 mg twice a day), 9 mg (4.5 mg twice a day), and 12 mg/day (6 mg twice a day) at minimum 2-week intervals if well tolerated
  • Patch: Initial dose of 4.6 mg once a day; may increase dose to 9.5 mg once a day and 13.3 mg once a day at minimum 4-week intervals if well tolerated
  • Oral solution: Same dosage as capsule
For current information about this drug’s safety and use, visit the www.fda.gov/Drugs. Click on "Drugs @ FDA," search for Exelon, and click on drug-name links to see "Label Information."
Namenda® (memantine)
  • Tablet*: Initial dose of 5 mg once a day
  • May increase dose to 10 mg/day (5 mg twice a day), 15 mg/day (5 mg and 10 mg as separate doses), and 20 mg/day (10 mg twice a day) at minimum 1-week intervals if well tolerated
  • Oral solution*: Same dosage as above
  • Extended-release capsule: Initial dose of 7 mg once a day; may increase dose to 14 mg/day, 21 mg/day, and 28 mg/day at minimum 1-week intervals if well tolerated
For current information about this drug's safety and use, visit www.namenda.com . See Full Prescribing Information (PDF, 555K).
Namzaric® (memantine extended-release and donepezil)
  • Capsule: 28 mg memantine extended-release + 10 mg donepezil once a day
  • 14 mg memantine extended-release + 10 mg donepezil once a day (for patients with severe renal impairment)

For current information about this drug’s safety and use, visit www.namzaric.com . Click on “Prescribing Information” to see the drug label.

Razadyne® (galantamine)
  • Tablet*: Initial dose of 8 mg/day (4 mg twice a day)
  • May increase dose to 16 mg/day (8 mg twice a day) and 24 mg/day (12 mg twice a day) at minimum 4-week intervals if well tolerated
  • Oral solution*: Same dosage as above
  • Extended-release capsule*: Same dosage as above but taken once a day
For current information about this drug’s safety and use, visit www.janseenpharmceuticals.com/assets/razadyne_er.pdf to see the drug label.

*Available as a generic drug.

Alzheimer's Weekly Store

MORE INFORMATION

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
1-800-438-4380 (toll-free)
adear@nia.nih.gov
www.nia.nih.gov/alzheimers

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.

SOURCES:

  1. Alzheimer's Disease Education and Referral (ADEAR) Center, A Service of the National Institute on Aging
  2. 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

5 comments :

  1. How long are these drugs effective? I am hearing some say they are only good for 18months....I have heard others say they were more coherent without the drugs....and I heard others who have been on them for years. Can you give me idea of how long they are effective? I want to do what is best for my husband, but the meds are expensive....

    ReplyDelete
    Replies
    1. There is a saying that, "When you have seen one person with Alzheimer's, you have seen one person with Alzheimer's." According to Consumer Reports, how well the drugs work and how long they work seems to be more of an art than a science, that although they can work well for many people, they help less than half the people who try it, that the only way to really know is through trial-and-error, and that a decent trial period is six-weeks long. When people say that they help for 18 months, what they probably mean is that when they do help, they can make a big difference that is easy to see for a such a while, then the effect becomes less noticeable, though research has shown that it can make at least a small, measurable difference for years, even in the most advanced stages. There are some side-effects and the pills can be expensive, so your question is an important one... sorry there is no simple answer, hope these insights help.

      Delete
  2. I'm on Aricept® (donepezil) and it helps alot. My wife can tell when I forgot to take it. I'm 52, early onset.

    ReplyDelete
  3. Also it's covered on my healthcare.

    ReplyDelete
  4. i have mild moder alz-- been on the big 4 drugs--currently gallantamine ? and really none seem to work---started a little exercise program and now GET UP WHEN wake up and this seems to make alot of difference--- laying in bed really bad news--i have no faith in nuerolgist; seems just want my money for no really help -hell i know i am getting worse and dont need a dr to thell that to me for 200--- Day 3 of program

    ReplyDelete

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