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Medications for Alzheimers Disease

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor, and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
There are no medications to cure Alzheimers disease, but certain medications are commonly prescribed to manage the symptoms. Other medications are under investigation in clinical trials.

Prescription Medications

Cholinesterase Inhibitors
Cholinesterase inhibitors most commonly prescribed for Alzheimers disease include:
  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Reminyl)
Cholinesterase inhibitors help enhance memory and other cognitive functions. This type of medication slows the breakdown of a chemical that helps cells communicate with one another. The longer this chemical exists the better the communication between brain cells. This may help to slow disease progression somewhat in people with mild-to-moderate Alzheimers disease.
Depending on which cholinesterase inhibitor you take, possible side effects include:
  • Nausea, vomiting
  • Diarrhea
  • Stomach pain or cramping
  • Slowing of heart rate
  • Fainting spells
  • Headache
  • Loss of appetite
  • Increased frequency of bowel movements
  • Liver problems (especially with tacrine)
  • Rashes
  • Dizziness
  • Nasal discharge
  • Facial flushing
Memantine (Namenda) is a newer type of medicine. It blocks the effects of a chemical that is believed to be toxic to nerve cells. Memantine is the first drug approved for treatment of moderate-to-severe Alzheimers disease. Improvements in daily functioning and cognition (thinking) have been seen. Memantine should not be used if you have severe kidney impairment.
Possible side effects of memantine include:
  • Headache
  • Confusion
  • Nausea, vomiting
  • Constipation
  • Drowsiness
  • Hallucinations
  • Cough
  • Diarrhea
Antidepressants
At least 25% of people with Alzheimers disease have depression. Antidepressants are used to treat low mood, depression, anxiety, and irritability. The antidepressants prescribed for Alzheimers disease belong to a group of medications known as selective serotonin reuptake inhibitors (SSRIs). SSRIs work by increasing the activity of the chemical serotonin in the brain.
SSRIs prescribed for Alzheimers disease include:
  • Citalopram (Celexa)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
Possible side effects of SSRIs include:
  • Drowsiness
  • Dryness of mouth
  • Blurred vision
  • Nausea
  • Dizziness
  • Weight gain
  • Difficulty sleeping
  • Sexual dysfunction
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients
Anti-anxiety Medications
Anti-anxiety medications (anxiolytics) help ease symptoms of anxiety, phobias, and excessive motor activity. The medications listed are in a class of medications called benzodiazepines. Benzodiazepines reduce symptoms of anxiety by enhancing the function of gamma aminobutyric acid (GABA). These drugs produce a sedative effect, decrease physical symptoms, such as muscle tension, and often cause drowsiness and lethargy. They can be habit-forming when used long term or in excess. These drugs should not be used more than prescribed since they may cause or worsen problems with memory. These drugs should also not be stopped abruptly since serious side effects, such as seizures, may result.
Benzodiazepines sometimes prescribed for Alzheimers disease include:
  • Lorazepam (Ativan)
  • Oxazepam (Serax)
Possible side effects of benzodiazepines include:
  • Drowsiness
  • Dizziness
  • Confusion
  • Weakness
  • Difficulty walking
  • Respiratory depression (decreasing breathing)
Antipsychotics
Antipsychotic medications are used for symptoms of agitation, hallucinations, delusions, bizarre behavior, and violent behavior. These drugs usually have a sedating effect on behavior and may not always be effective for patients with Alzheimers disease.
Antipsychotics sometimes prescribed for Alzheimers disease include:
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
Possible side effects of olanzapine include:
  • Agitation
  • Behavior problems
  • Difficulty in speaking or swallowing
  • Restlessness or need to keep moving
  • Stiffness of arms or legs
  • Trembling or shaking of hands and fingers
Possible side effects of risperidone and quetiapine include:
  • Tardive dyskinesia (fine, worm-like movements of the tongue, or other uncontrolled movements of the mouth, tongue, cheeks, jaw, shoulders, arms, or legs)
In some cases these side effects are not reversible.
Nonprescription Medications
Antioxidants
The antioxidant vitamin E has been studied in combination with selegiline (Eldepryl), a medication used to treat Parkinson’s disease, for possible protective effects against the progression of Alzheimers disease. Vitamin E is an antioxidant and may help prevent brain cell damage.
It is not clear that vitamin E provides any benefit. Further research is needed to conclusively determine the potential benefits of vitamin E in Alzheimers disease. Some doctors are recommending vitamin E as a potential preventive measure. However, since vitamin E can increase the risk of bleeding when taken with other medications, such as aspirin or warfarin (a blood thinning medicine), you should talk with your doctor before beginning it.

Special Considerations

If you are taking medications, follow these general guidelines:
  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Ask what results and side effects to expect. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.

References

Alzheimers disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 11, 2012. Accessed August 22, 2012.

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Published May 22, 2009. Accessed August 22, 2012.

Burns A. Alzheimer’s disease: on the verges of treatment and prevention. Lancet Neurology. 2009;8:4-5.

Kamat CD, Gadal S, et al. Antioxidants in central nervous system diseases: preclinical promise and translational challenges. J Alzheimers Dis. 2008;15(3):473-493.

Neogroschul J, Sano M. Current treatment and recent clinical research in Alzheimer’s disease. Mt Sinai J Med. 2010;77(1):3-16.

Treatments for Alzheimers. Alzheimer’s Association website. Available at: http://www.alz.org/alzheimers%5Fdisease%5Ftreatments.asp. Accessed August 22, 2012.

United States Pharmacopeial Convention. USP DI. 21st ed. Englewood, CO: Micromedex; 2001.

Von Arnim CA, Herbolsheimer F, et al. Dietary antioxidants and dementia in a population-based case-control study among older people in South Germany. J Alzheimers Dis. 2012;31(4):717-724.

2/18/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

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