Drug Treatments for Alzheimer's Disease in FADIC Blog

Drug Treatments for Alzheimer’s Disease

Brand Names: Aricept
Therapeutic Category: Acetylcholinesterase Inhibitor (Central)
Dosage Forms: Tablet, Oral
Use: Labeled Indications: Treatment of mild, moderate, or severe dementia of the Alzheimer’s type “Drug Treatments for Alzheimer’s Disease.”
Off-label: Dementia associated with Parkinson’s disease/ Traumatic brain injury
Dosing: Adult: Alzheimer’s disease: Oral:
Mild-to-moderate: Initial: 5 mg once daily; may increase to 10 mg once daily after 4 to 6 weeks; effective dosage range in clinical studies: 5 to 10 mg/day
Moderate-to-severe: Initial: 5 mg once daily; may increase to 10 mg once daily after 4 to 6 weeks; may increase further to 23 mg once daily after ≥3 months; effective dosage range in clinical studies: 10 to 23 mg/day

Dose Adjustments
Renal Impairment: no dosage adjustments
Hepatic Impairment: no dosage adjustments
Adverse Drug Interaction:
Insomnia, Nausea, Diarrhoea, Hypertension, chest pain, syncope
Pharmacodynamics/Kinetics:
Metabolism: Extensive hepatic metabolism
Half-life elimination: 70 hours; time to steady-state: 15 days
Time to peak, plasma: Tablet, 10 mg: 3 hours; Tablet, 23 mg: 8 hours
Important Notes:
Altered cardiac conduction: Donepezil associated with QT prolongation and torsades de pointes; use with caution in patients at risk of prolonged cardiac repolarization
Pregnancy & Lactation: Adverse events observed in some animal reproduction studies / not known if present in breast milk
Medication Safety issue:

Aricept confused with Aciphex, Ascriptin, and Azilect

Brand Names: MYLAN-Memantine
Therapeutic Category: N-Methyl-D-Aspartate (NMDA) Receptor Antagonist
Dosage Forms: Tablet/solution, Oral
Use: Labeled Indications: Alzheimer’s disease
Off-label: Vascular dementia (mild to moderate)
Dosing: Adult Drug Treatments for Alzheimer’s Disease, moderate to severe: Oral:
Immediate release: Initial: 5 mg daily; increase dose by 5 mg daily (if the previous dose is well tolerated) to a target dose of 20 mg daily.
Wait ≥1 week between dosage changes. Doses >5 mg daily should be given in 2 divided doses

Dose Adjustments
Renal Impairment: Severe impairment: CrCl 5 to 29 mL/minute: Immediate release: Initial: 5 mg once daily; after at least one week of therapy and if tolerated, may titrate up to a target dose of 5 mg twice daily
Hepatic Impairment: no dosage adjustments
Adverse Drug Interaction:
Hypertension, Dizziness, confusion, headache, anxiety, depression, hallucination, pain
Pharmacodynamics/Kinetics:
Half-life elimination: Terminal: 60 to 80 hours
Time to peak, serum: Immediate release: 3 to 7 hours
Absorption: Well absorbed
Excretion: Urine
Important Notes:
Cardiovascular disease: Use with caution in patients with cardiovascular disease.
Although adverse cardiac events were infrequent in clinical trials, an increased incidence of cardiac failure, angina, bradycardia, and hypertension was observed.
Pregnancy & Lactation: Adverse events have been observed in some animal reproduction studies / not known if present in breast milk
Medication Safety issue of Drug Treatments for Alzheimer’s Disease
Memantine confused with mesalamine, methadone