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Dementia: Medications

Table 10.2: Medications for dementia





galan- tamine (reminyl)

rivastig- mine (exelon)



Initial dose*

5 mg

4 mg po bid


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


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



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


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



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




At publica- tion, not covered on any provincial drug formu- laries; cost is





*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.