Your Guide to Treatment Medications for Alzheimer’s Disease

Types of Alzheimer’s medications

Alzheimer’s medications are designed to manage symptoms and improve quality of life. They fall into several categories, each working differently to address various aspects of the disease.

Here’s an overview of the main types.

Cholinesterase inhibitors

Cholinesterase inhibitors work by increasing levels of acetylcholine, a neurotransmitter that’s typically low in people with Alzheimer’s. This can help improve the ability to think and memory.

Commonly prescribed medications include:

• Donepezil (Aricept): Used for mild to moderate Alzheimer’s and sometimes for severe cases, donepezil increases acetylcholine levels to improve communication between nerve cells.
• Rivastigmine (Exelon): This drug is available as a pill or a patch. It’s used for mild to moderate Alzheimer’s and dementia related to Parkinson’s disease. It also increases acetylcholine levels.
• Galantamine (Razadyne): Used for mild to moderate Alzheimer’s, galantamine not only inhibits cholinesterase but also enhances the release of acetylcholine.

NMDA receptor antagonists

NMDA receptor antagonists work by regulating the activity of glutamate, another neurotransmitter that can be overactive in Alzheimer’s disease. This helps prevent excessive neuronal damage and improves cognitive function.

Memantine (Namenda) is the most commonly prescribed NMDA receptor antagonist. It’s used for moderate to severe Alzheimer’s. It regulates glutamate activity to protect brain cells from excessive stimulation and helps with memory and learning.

Combination drugs

Combination drugs combine a cholinesterase inhibitor and an NMDA receptor antagonist to address different aspects of Alzheimer’s simultaneously.

Namzaric is the primary combination drug approved by the Food and Drug Administration (FDA) for treating Alzheimer’s.

Namzaric combines donepezil and memantine into a single pill. It’s used for moderate to severe Alzheimer’s disease and aims to enhance overall thinking ability and manage symptoms more effectively.

Commonly prescribed medications

Donepezil (Aricept)

Donepezil is a cholinesterase inhibitor that increases levels of acetylcholine, a neurotransmitter essential for memory and learning.

Donepezil helps people with Alzheimer’s by improving cognition and behavior, although it does not slow or stop the progression of the disease.

Doctors typically prescribe it as a daily oral tablet, starting at 5 milligrams (mg), with a maximum dose of 10 mg.

For severe cases, the dose may be increased to 23 mg.

Common side effects include:

• nausea
• diarrhea
• insomnia
• muscle cramps
• fatigue

More serious effects can include bradycardia (slow heart rate) and gastrointestinal bleeding.

Donepezil may interact with other medications that affect heart rate or gastrointestinal motility, such as anticholinergic drugs and nonsteroidal anti-inflammatory drugs (NSAIDs).

Rivastigmine (Exelon)

Rivastigmine, another cholinesterase inhibitor, works by increasing acetylcholine levels. It’s available in an oral and transdermal patch form:

• Oral form: Rivastigmine dosage starts at 1.5 mg twice daily and can be increased to a maximum of 6 mg twice daily (12 mg daily).
• Transdermal patch: The patch dosage usually starts at 4.6 mg per day. After a period of adjustment, the dosage can be increased to 9.5 mg per day and, in some cases, further increased to 13.3 mg per day (the maximum recommended dose for the patch).

Side effects can include:

• nausea
• vomiting
• diarrhea
• loss of appetite
• weight loss

Severe effects potentially include gastrointestinal issues and heart problems.

Rivastigmine may interact with other cholinesterase inhibitors and drugs that increase the risk of gastrointestinal bleeding.

Galantamine (Razadyne)

Galantamine is a cholinesterase inhibitor that also works on nicotinic receptors to enhance acetylcholine levels.

A 2015 study found that galantamine, particularly at a daily dose of 24 mg, significantly improved cognitive outcomes in participants with Alzheimer’s disease.

Galantamine dosage is typically started at 4 mg twice daily, with a maximum dose of 12 mg twice daily. Extended-release formulations begin at 8 mg once daily, with a maximum dosage of 24 mg per day.

Common side effects include:

• nausea
• vomiting
• diarrhea
• dizziness
• headache

Serious side effects can involve liver issues and bradycardia.

Galantamine can interact with other cholinesterase inhibitors and medications affecting liver enzymes, such as certain antibiotics and antifungals.

Memantine (Namenda)

Memantine is an NMDA receptor antagonist that helps regulate glutamate activity in the brain, protecting nerve cells from excessive stimulation.

Research suggests that memantine can delay the worsening of practical activities and mental performance, with about 1 out of 10 people over 6 months experiencing this benefit. It may also help alleviate severe restlessness and improve mood.

Memantine is typically started at 5 mg once daily, gradually increasing to a maximum of 20 mg per day (10 mg twice daily).

Side effects may include:

• dizziness
• headache
• confusion
• constipation
• high blood pressure

Severe effects include allergic reactions.

Memantine may interact with other drugs affecting renal function and can be influenced by medications that alter urinary pH.

Namzaric

Namzaric combines donepezil and memantine into a single pill, addressing different aspects of Alzheimer’s disease.

One 2020 study found that in people with Alzheimer’s disease, using memantine and donepezil together is better than a placebo for:

• improving thinking
• overall health
• daily activities
• mood

However, this combination isn’t as well tolerated as using each drug alone.

The usual dose of Namzaric involves a single pill that contains both donepezil and memantine. This typically involves donepezil at 10 to 23 mg and memantine at 10 to 20 mg, tailored to the individual’s needs.

This combination can lead to side effects from both drugs, such as:

• nausea
• diarrhea
• dizziness
• fatigue

Interactions can occur with drugs affecting heart rate, gastrointestinal motility, and renal function.

Aducanumab (Aduhelm)

Aducanumab is a monoclonal antibody that targets and helps reduce amyloid-beta plaques in the brain. It’s administered as an intravenous infusion, typically every 4 weeks after an initial loading phase.

A 2022 study analyzed two trials. In one trial, high dose aducanumab led to a 22% reduction in Alzheimer’s symptoms compared with a placebo. However, the other trial didn’t show significant improvement.

Both trials confirmed that aducanumab reduces key Alzheimer’s disease biomarkers, though the results varied.

Side effects include brain swelling (ARIA-E) and microhemorrhages (ARIA-H) as well as headache and confusion.

Aducanumab requires careful monitoring for interactions with other treatments that affect brain function or increase bleeding risk.

New and emerging treatments

New and emerging treatments for Alzheimer’s disease focus on targeting the underlying mechanisms of the disease, such as amyloid plaques, tau tangles, and inflammation.

Here are some promising approaches:

• Aducanumab (Aduhelm): This drug is an anti-amyloid antibody that targets amyloid plaques in the brain, aiming to slow the progression of Alzheimer’s. It was the first FDA-approved treatment to address the disease’s underlying pathology.
• Lecanemab (Leqembi): Another anti-amyloid antibody similar to aducanumab, lecanemab was granted accelerated approval by the FDA in early 2023.
• Donanemab (Kisunla): This drug is a monoclonal antibody targeting amyloid plaques. Early clinical trials have shown it may slow cognitive decline in people with early Alzheimer’s.
• Gene therapy: Researchers are exploring gene-editing techniques like CRISPR to potentially correct genetic mutations associated with Alzheimer’s, though this is still in the early stages.
• BACE inhibitors: These drugs inhibit the beta-secretase enzyme, which is involved in the production of amyloid-beta, the main component of amyloid plaques. While early trials faced challenges, research continues in this area.
• Neuroinflammation-targeting drugs: Some treatments aim to reduce inflammation in the brain, which is believed to play a role in Alzheimer’s progression. Drugs like AL002, targeting microglial cells, are under investigation.
• Stem cell therapy: Research is ongoing into using stem cells to regenerate damaged brain cells and restore thinking ability in people with Alzheimer’s disease.
• Neuroprotective agents: Drugs like sirtuins and compounds that boost mitochondrial function are being studied for their potential to protect brain cells from damage.
• Lifestyle interventions and supplements: Combining diet, exercise, and cognitive training with supplements like omega-3 fatty acids and antioxidants is being explored as a way to delay the onset or slow the progression of Alzheimer’s.

Managing medication tips

It can be overwhelming to process an Alzheimer’s diagnosis while taking new medications. Here are some tips that can help:

• Set a routine: Take medications at the same time daily. It may help to take them during a meal.
• Set reminders: Consider setting alarms on your phone or downloading medication apps for timely doses.
• Use a pill organizer: Keep track of doses with a weekly or monthly organizer.
• Keep a log: Record each dose in a log for easy tracking.
• Know your medications: Understand what each medication does and its potential side effects.
• Avoid interactions: Tell your doctor about all of the medications and supplements you take.
• Simplify doses: Ask your doctor about combining or reducing the frequency of doses.
• Monitor side effects: Watch for and report any changes in behavior or health. Consider asking a loved one to help you monitor behavior changes, too.
• Plan for missed doses: Know what to do if a dose is missed. Your doctor or pharmacist is a great resource.
• Stay hydrated: Encourage regular water intake unless your doctor tells you otherwise.

Takeaway

Alzheimer’s medications can’t stop the disease, but they play a crucial role in managing symptoms and improving daily life. Regular check-ins with your doctor are key to ensuring these treatments remain effective as the condition evolves.