Dementia: Medications
Table 10.2: Medications for dementia
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| donepezil (aricept) | galan- tamine (reminyl) | rivastig- mine (exelon) | memantine (ebixa) |
| Initial dose* | 5 mg | 4 mg po bid (regular) 8 mg po od (extended release XR) | Oral: 1.5 mg po bid Patch: One 5 cm2 patch daily | 5 mg po od |
| Titration schedule | Increase by 5 mg every 4 weeks | Increase by 8 mg every 4 weeks | Increase by 3 mg in divided doses every 4 weeks. Patch: In- crease to one 10 cm2 patch daily after 4 weeks | Increase by 5 mg every week, start by adding second 5 mg dose |
| Maximum dose | 10 mg | 12 mg po bid 24 mg po od | 6 mg po bid | 10 mg po bid |
| Formulations | Tablets | Immediate release tablets taken bid, ex- tended release tablet taken once daily | Tablet taken bid Transder- mal patch recently re- leased which is applied daily | Tablets given bid |
| Indications | Mild to moder- ate Alzheim- er's disease | Mild to moderate Alzheimer's disease | Mild to moderate Alzheimer's disease | Adjunctive treatment added to cholinester- ase inhibitor therapy in moderate to severe Alzheimer's disease |
| Other potential indications | Vascular dementia Emerging evidence in se- vere dementia | Evidence in mixed Alzheimer's and vascular dementia | Best sup- ported treatment in Parkinson's dementia and demen- tia with Lewy bodies |
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| Side-effects | Contraindicat- ed with history of sick-sinus syndrome, left bundle branch block, recent peptic ulcer disease
Common side-effects: Muscle cramps Insomnia Nausea Diarrhea (MIND) | Similar to donepezil | Similar to donepezil
Gastro- intestinal side-effects often more pronounced | Common side-effects: Confusion Headache Equilibrium (dizziness) Constipation Kidney (requires dose adjust- ment in renal failure as per CPS) (CHECK) |
| Other notes |
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| At publica- tion, not covered on any provincial drug formu- laries; cost is ~$200.00/ month |
*All cholinesterase inhibitors should be given in the morning to minimize sleep disturbance. Lower starting doses and slower dose titration may be necessary in some individuals who are sensitive to side-effects.