Dementia medication

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  • The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine, as monotherapies, are recommended as options for managing mild to moderate Alzheimer's disease.
  • Memantine monotherapy is recommended as an option for managing Alzheimer's disease for people with:
    • Moderate Alzheimer's disease who are intolerant of or have a contraindication to AChE inhibitors or
    • Severe Alzheimer's disease.
  • For people with an established diagnosis of Alzheimer's disease who are already taking an AChE inhibitor:
    • Consider memantine in addition to an AChE inhibitor if they have moderate disease
    • Offer memantine in addition to an AChE inhibitor if they have severe disease.
  • Treatment should be under the following conditions:
    • For people who are not taking an AChE inhibitor or memantine, prescribers should only start treatment with these on the advice of the older adult psychiatric team
    • For people with an established diagnosis of Alzheimer's disease who are already taking an AChE inhibitor, primary care prescribers may start treatment with memantine without taking advice from a specialist clinician.
    • Do not stop AChE inhibitors in people with Alzheimer's disease because of disease severity alone
  • For further information see AChEI and memantine in dementia guideline

DONEPEZIL

Therapy notes

Formulation and dosage details

Formulation:

Tablets 5mg (s)

Dosage:

Initially 5mg once daily, increased if necessary after 1 month to 10mg once daily.

Formulation and dosage details

Formulation:

Orodispersible tablets 5mg, 10mg (s)

Dosage:

Initially 5mg once daily, increased if necessary after 1 month to 10mg once daily.

The orodispersible tablet should be placed on the tongue, allow to disperse, and swallow.

GALANTAMINE

Therapy notes

Formulation and dosage details

Formulation:

Modified release capsules 8mg, 16mg, 24mg (s)

Dosage:

Initially 8mg once daily for 4 weeks increased to 16mg once daily for 4 weeks; maintenance 16 to 24mg daily.

Formulation and dosage details

Formulation:

Oral solution 4mg/mL (s)

Dosage:

Initially 8mg once daily for 4 weeks increased to 16mg once daily for 4 weeks; maintenance 16 to 24mg daily.

RIVASTIGMINE

Therapy notes


MHRA advice: Rivastigmine (Exelon) transdermal patch: risk of medication errors (December 2014) (www.gov.uk).
Risk minimisation materials

  • If switching a patient from oral to transdermal therapy refer to BNF.

Formulation and dosage details

Formulation:

Capsules 1·5mg, 3mg, 4·5mg, 6mg (s)

Dosage:

By mouth: initially 1·5mg twice daily, increased in steps of 1·5mg twice daily at intervals of at least 2 weeks according to response and tolerance; usual range 3mg to 6mg twice daily; maximum 6mg twice daily.

Formulation and dosage details

Formulation:

Oral solution 2mg/mL (s)

Dosage:

By mouth: initially 1·5mg twice daily, increased in steps of 1·5mg twice daily at intervals of at least 2 weeks according to response and tolerance; usual range 3mg to 6mg twice daily; maximum 6mg twice daily.

Formulation and dosage details

Formulation:

Transdermal patch 4·6mg/24hours, 9·5mg/24 hours (s)

Dosage:

Transdermal patch, initially apply 4·6mg/24 hours patch daily, if well tolerated increase to 9·5mg/24 hours patch daily after no less than 4 weeks.

MEMANTINE

Therapy notes

  • Memantine is an alternative treatment recommended in moderate Alzheimer’s disease where the cholinesterase inhibitors cannot be used. It is also recommended as an option in severe Alzheimer’s disease.

Formulation and dosage details

Formulation:

Tablets 10mg, 20mg (s)

Dosage:

Initially 5mg once daily, increased in steps of 5mg at weekly intervals to maximum of 20mg daily. Reduced dose in renal impairment, refer to BNF.

Formulation and dosage details

Formulation:

Oral solution 5mg/actuation (10mg/mL) (s)

Dosage:

Initially 5mg once daily, increased in steps of 5mg at weekly intervals to maximum of 20mg daily. Reduced dose in renal impairment, refer to BNF.