Dementia Drugs

Question 1

Cholinesterase Inhibitors

Answer 1

1. Donepezil
2. Rivastigmine
3. Galantamine

Question 2

Donepezil formulation

Answer 2

23 mg Tablet (Aricept)
10 mg Tablet
5 mg Tablet

Question 3

Donepezil dosing

Answer 3

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

Question 4

Rivastigmine formulation

Answer 4

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

Question 5

Rivastigmine dosing and route

Answer 5

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

Question 6

Galantamine formulation

Answer 6

PR Capsules: 8 mg, 16 mg, 24 mg

Question 7

Galantamine dosing

Answer 7

Range: 16 to 24 mg QD (If therapy is interrupted for ≥3 days, restart at the lowest dose and increase to current dose)

Question 8

AChE Inhibitor Monitoring Parameters

Answer 8

ECG (QTc): Risk factors in older adults, CVD, stroke

BP/HR

Question 9

ADRs for AChE inhibitors

Answer 9

1. NVD (Cholinergic effect)
2. Drowsiness
3. Difficulty sleeping (Patch)
4. Skin irritation (Patch)
5. Weight loss, reduced appetite (Dose-related cholinergic activity that increases smooth muscle contraction)

Question 10

NMDA Antagonist

Answer 10

Memantine

Question 11

Indications of memantine

Answer 11

Alzheimer’s Disease
Dementia
Neurocognitive toxicity of whole brain irradiation (Prevention)
Skin picking disorder

Question 12

Memantine formulation and dosing

Answer 12

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

Question 13

ADRs of memantine to monitor

Answer 13

Neuropsychiatric effects:
- Common: confusion, dizziness, drowsiness, and headache
- Others: Loss of consciousness, sleep disturbance, seizures
- Rare: Agitation, delusion, hallucination