Dementia drugs

Question 1

Class of drugs for mild-moderate dementia vs class of drugs for severe dementia

Answer 1

Mild-moderate: Cholinesterase Inhibitors (Donepezil (ARICEPT); Galantamine extended release (REMINYL ER);
Rivastigmine (Exelon oral / EXELON patch))

Severe: NMDA Receptor Antagonists (Memantine (EBIXA))

Question 2

Cholinesterase inhibitors side FX.

Use with caution in which patients?

Answer 2

Common side effects: Nausea/vomiting/diarrhea, headache, dizziness. Use with caution in patients with risk of ulcers, history of seizures, asthma/COPD.

Question 3

Donepezil

Answer 3

Cholinesterase inhibitor - (ARICEPT) start at 5mg QD, if well-tolerated increase to 10mg QD after at least 4-6 weeks. Contraindicated in those with conduction abnormalities or unexplained syncope.

Question 4

Galantamine extended release

Answer 4

Cholinesterase inhibitor - (REMINYL ER) start at 8mg QAM with food. After 4 weeks, increase to 16mg QD (initial maintenance dose). If well tolerated, consider increasing to 24mg QD after at least 4 weeks. Contraindicated in those with conduction abnormalities, unexplained syncope, severe renal or hepatic impairment. Monitor body weight if weight loss is a concern.

Question 5

Rivastigmine

Answer 5

Cholinesterase inhibitor - (Exelon oral / EXELON patch): ORAL: start 1.5mg po BID with food. If well tolerated, in two week increments, increase to 4.5mg BID then 6mg BID (maximum dose). If stopped for more than a few days, restart titration. TRANSDERMALL: start at 4.6mg/24hours. After at least 4 weeks, if well tolerated, increase to 9.5mg/24hours. The patient/family should be reminded that it is critical to remove the last patch when applying a new one as having more than one can be toxic.

Question 6

Memantine

Answer 6

NMDA receptor antagonist - (EBIXA) start 5mg QAM. If well tolerated, increase in weekly increments of 5mg to maintenance dose of 10mg BID. Contraindicated in those with severe renal impairment. Use with caution in patients with a history of cardiovascular disease and those with history of seizure. Conditions that raise urinary pH (renal tubular acidosis,UTI with proteus bacteria) can reduce elimination. Do not combine with related drugs such as amantadine, ketamine, dextromethorphan.