Dementia Drugs Flashcards
Cholinesterase Inhibitors
- Donepezil
- Rivastigmine
- Galantamine
Donepezil formulation
23 mg Tablet (Aricept)
10 mg Tablet
5 mg Tablet
Donepezil dosing
Mild AD and other dementias:
5 mg QD → 10 mg QD
Moderate AD: 5 mg QD → 10 mg QD → 23 mg QD
Titrate after 4 to 6 weeks, then up to 23 mg if stable on 10 mg
Rivastigmine formulation
Capsules: 1.5 mg, 3 mg, 4.5 mg, 6 mg
Patches: 4.6 mg/24 h, 9.5 mg/24 h, 13.3 mg/24 h
Rivastigmine dosing and route
Alzheimer’s, PD dementia:
PO 1.5 mg BD → 3 mg QD (Titrate every 2 weeks, maximum 6 mg BD)
Transdermal 4.6 mg QD → 9.5 mg QD → 13.3 mg (Titrate every 4 weeks)
Oral form for vascular dementia, dementia with Lewy bodies
Galantamine formulation
PR Capsules: 8 mg, 16 mg, 24 mg
Galantamine dosing
Range: 16 to 24 mg QD (If therapy is interrupted for ≥3 days, restart at the lowest dose and increase to current dose)
AChE Inhibitor Monitoring Parameters
ECG (QTc): Risk factors in older adults, CVD, stroke
BP/HR
ADRs for AChE inhibitors
- NVD (Cholinergic effect)
- Drowsiness
- Difficulty sleeping (Patch)
- Skin irritation (Patch)
- Weight loss, reduced appetite (Dose-related cholinergic activity that increases smooth muscle contraction)
NMDA Antagonist
Memantine
Indications of memantine
Alzheimer’s Disease
Dementia
Neurocognitive toxicity of whole brain irradiation (Prevention)
Skin picking disorder
Memantine formulation and dosing
10 mg Tablets
Initial doses: 5mg/day, titrate every week (Can be once daily or 2 divided doses)
Maximum dose: 20 mg/day
CrCL < 50 mL/min: 5 mg QD, titrate at least 1 week of therapy, to 5 mg BD
ADRs of memantine to monitor
Neuropsychiatric effects:
- Common: confusion, dizziness, drowsiness, and headache
- Others: Loss of consciousness, sleep disturbance, seizures
- Rare: Agitation, delusion, hallucination