The why, what, how, and when of drugs for Alzheimer’s disease

why what when

A person with Alzheimer’s disease may take drugs for three main reasons; to treat the condition itself, to treat personality and behavior changes caused by the condition, and to treat other medical conditions that they may have in addition to Alzheimer. As a caregiver, you need to ask the doctor or pharmacist certain questions about your care receiver’s prescription drugs.

Questions to ask your doctor about Alzheimer’s disease drugs

Why

·         is the medications being used?

 

What

·         positive effects should you expect?

·         are the side effects?

·         can you do about side effects?

How

·         long will the patient need to take the medication?

·         much should the person take every day?

When

·         does the patient need to take it?

·         should you expect positive results?

 

Can

·         the medication be crushed and mixed into foods?

·         you get the medication in liquid form?

·         this medication cause negative interactions if taken with other medications?

 

Drugs that treat Alzheimer’s disease

Several individual factors help to determine which drugs a given person with Alzheimer should take, including genes, lifestyle, previous treatments, other conditions, the patient’s environment, and the stage of the disease. Currently there are three drugs to treat mild to moderate Alzheimer’s disease (Razadyne, Exelon, and Aricept), and a fourth one to treat moderate to severe Alzheimer (Namenda).

Alzheimer’s disease drugs

Namenda

Generic name

Memantine

Type and use

N-methyl D-aspartate (NMDA) antagonist to treat moderate to severe symptoms.

Mechanism of action

Blocks toxic effects linked to excess glutamate, regulates glutamate activation.

Side effects

Dizziness, headache, constipation, confusion.

Recommended dosage

Tablet and oral solution: 5mg per day, may increase to 5mg twice per day, 15mg per day (5 mg and 10mg as separate doses), and 10mg twice per day at minimum 1-week intervals if tolerated.

Extended release: 7mg per day, may increase to 14 mg, 21mg, and 28mg per day at minimum 1-week intervals if tolerated.

More info

http:perperwww.namenda.comper

http:perperwww.frx.comperpipernamenda_pi.pdf

Razadyne

Generic name

Galantamine

Type and use

Cholinesterase inhibitor to treat mild to moderate symptoms.

Mechanism of action

Prevents breakdown of acetylcholine, stimulates nicotinic receptors to release more acetylcholine in the brain.

Side effects

Nausea, vomiting, diarrhea, weight loss, appetite loss.

Recommended dosage

Tablet and oral solution: 4mg twice per day, may increase to 8mg twice per day, and 12mg twice per day at minimum 4-week intervals if tolerated.

Extended release: same as above but once per day.

More info

http:perperwww.razadyneer.comper

http:perperwww.razadyneer.compersitesperdefaultperfilespersharedperpiperrazadyne_er.pdf#zoom=100

Exelon

Generic name

Rivastigmine

Type and use

Cholinesterase inhibitor to treat mild to moderate symptoms.

Mechanism of action

Prevents breakdown of acetylcholine and butyrylcholine in the brain.

Side effects

Nausea, vomiting, diarrhea, weight loss, appetite loss, muscle weakness.

Recommended dosage

Capsule and oral solution: 1.5mg twice per day, may increase to 3mg, 4.5mg, and 6mg twice per day, at minimum 2-week intervals if tolerated.

Patch (for severe symptoms): 4.6gm per day, may increase to 9.5gm and 13.3gm per day at minimum 4-week interval if tolerated.

More info

http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview&DrugName=EXELON

Aricept

Generic name

Donezepil

Type and use

Cholinesterase inhibitor to treat mild to moderate and moderate to severe symptoms.

Mechanism of action

Prevents breakdown of acetylcholine in the brain.

Side effects

Nausea, vomiting, diarrhea.

Recommended dosage

Tablet and orally disintegrating tablet: 5mg per day, may increase to 10mg per day after 4 to 6 weeks if tolerated, and to 23mg per day after at least 12 weeks.

More info

http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview&DrugName=ARICEPT

 

Drugs to treat Alzheimer-related behavior problems

Two types of drugs are mostly used to treat behavior changes related to Alzheimer’s disease such as depression, aggression, restlessness, and anxiety. These two types are antidepressants and anticonvulsants.

Antidepressants (for depression and anxiety)

·         Celexa (citalopram).

·         Remeron (mirtazapine).

·         Zoloft (sertraline).

Anticonvulsants (for severe agression)

·         Depakote (sodium valproate).

·         Tegretol (carbamazepine).

·         Trileptal (oxcarbazepine).

Insomnia, anxiety, and paranoia, hallucinations, and agitation are other behavior changes associated with Alzheimer’s disease. There are drugs to treat these problems but they should be used with caution, and only after the physician has explained their risks and side effects, and when safer drugs have proven unsuccessful. 

Alzheimer’s disease drugs to use with caution

Use

Examples

Side effects

Sleep aids

·         Ambient (zolpidem).

·         Lunesta (eszopiclone).

·         Sonata (zaleplon).

·         Falls.

·         Confusion.

Anti-anxiety drugs

·         Ativan (lorazepam).

·         Klonopin (clonazepam).

·         Sleepiness.

·         Dizziness.

·         Falls.

·         Confusion.

Antipsychotics

·         Risperdal (rtisperidone).

·         Seroquel (quetiapine).

·         Zyprexa (olanzapine).

·         Risk of death in some elderly people with dementia.

 

Sleep aids and anti-anxiety drugs should only be used for short periods of time and not regularly. Antipsychotics should only be administered when the physician determines that symptoms are severe. For all drugs in general, remember to use the lowest possible dose, watch for adverse effects (and stop treatment should they occur), and give the drug a couple of weeks to be effective.

Drugs that treat other conditions

Diabetes, high blood pressure, and heart disease are some of the medical conditions common in people with Alzheimer’s disease. Make a list of all the medications that person you provide care for has been prescribed. This list may help you keep track of all the different treatments, and you may also bring it to doctor’s appointments (a patient may have several different doctors and they may not be aware of what the others have prescribed). Consider a pill organizer to make sure the person takes his or her medicines.

Bad medicine

Anticholinergic drugs like atrovent (ipratropium), combivent (ipratropium and albuterol), duoneb (ipratropium and albuterol), or spiriva (tiotropium) may cause dangerous side effects for a person with Alzheimer’s disease. If the patient suffers from sleeping problems, stomach cramps, incontinence, asthma, motion sickness, or muscle spasms – which these drugs are used to treat –, ask the doctor about safer alternatives to treat these problems.