Medications for Alzheimer’s Disease

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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, so ask your healthcare provider if you need to take any special precautions. Use each of these medications only as recommended by your healthcare provider, and according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider.

There are no medications to cure Alzheimer’s disease, but certain medications are commonly prescribed to manage the symptoms.

Prescription Medications

* Cholinesterase inhibitors
* Glutamate blockers
* Antidepressants
* Anxiolytics
* Antipsychotics

Over-the-Counter Medications

* Antioxidants (Vitamin E)



Prescription Medications

Cholinesterase Inhibitors

Cholinesterase inhibitors most commonly prescribed for Alzheimer’s disease include:

* Tacrine (Cognex)
* Donepezil (Aricept)
* Rivastigmine (Exelon)
* Galantamine (Reminyl)

Cholinesterase inhibitors help enhance memory and other cognitive functions by influencing certain chemical interactions in the brain. The drugs function by slowing the breakdown of acetylcholine, the chemical that helps cells communicate with one another. By slowing the breakdown process, acetylcholine remains in the brain longer, thus enabling cells to communicate more efficiently. This may help to slow disease progression somewhat in people with mild to moderate Alzheimer's 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


Glutamate Blockers

Namenda (memantine) is a new type of medication that acts by blocking the effects of the chemical glutamate at a specific receptor in the brain (the NMDA receptor.) Memantine is the first drug approved by the US Food and Drug Administration (FDA) for treatment of moderate to severe Alzheimer’s disease. (Cholinesterase inhibitors are approved for mild to moderate disease). Improvements in daily functioning and cognition (thinking) have been observed in Alzheimer’s patients. 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 Alzheimer’s disease have depression; identification with treatment may improve cognition.

Selective serotonin reuptake inhibitors (SSRIs) prescribed for Alzheimer’s disease include:

* Citalopram (Celexa)
* Fluoxetine (Prozac)
* Paroxetine (Paxil)
* Sertraline (Zoloft)

Antidepressants are used to treat low mood, depression, anxiety, and irritability. The antidepressants prescribed for Alzheimer’s disease belong to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). SSRIs work by increasing the activity of the chemical serotonin in the brain.

Please note: In March 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Reuptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.

Possible side effects of SSRIs include:

* Drowsiness
* Dryness of mouth
* Blurred vision
* Nausea
* Dizziness
* Difficulty sleeping
* Sexual dysfunction


Anxiolytics

Benzodiazepines sometimes prescribed for Alzheimer’s disease include:

* Lorazepam (Ativan)
* Oxazepam (Serax)

Anxiolytics (anti-anxiety medications) 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, a symptom experienced by most people with Alzheimer’s disease. These drugs should also not be stopped abruptly since serious side effects such as seizures may result.

Possible side effects of benzodiazepines include:

* Drowsiness
* Dizziness
* Confusion
* Weakness
* Difficulty walking


Antipsychotics

Antipsychotic medications are used for symptoms of agitation, hallucinations, delusions, bizarre behavior, and violent behavior.

Antipsychotics sometimes prescribed for Alzheimer’s disease include:

* Olanzapine (Zyprexa)
* Risperidone (Risperdal)
* Quetiapine (Seroquel)

Antipsychotic medications are most commonly used to treat hallucinations (seeing, hearing, or feeling things that are not really there), delusions (false beliefs), aggression, and hostility. These drugs usually have a sedating effect on behavior and may not always be effective for patients with Alzheimer’s disease.

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)



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 Alzheimer’s disease. Vitamin E is an antioxidant and may help prevent brain cell damage.

Further research is needed to conclusively determine the potential benefits of vitamin E in Alzheimer’s disease. Since vitamin E poses few side effects, is available over-the-counter, and is relatively inexpensive, some physicians 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 medication), you should talk with your doctor before beginning it.


Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

* Take them as directed—not more, not less, not at a different time.
* Do not stop taking them without consulting your healthcare provider.
* Don’t share them with anyone else.
* Know what effects and side effects to expect, and report them to your healthcare provider.
* If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
* Plan ahead for refills so you don’t run out.


REFERENCES:

Alzheimer’s Association website. Available at: http://www.alz.org/ .

USP DI. 21st ed. Micromedex; 2001.
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by Michelle Badash, MS

Last reviewed April 2007 by Roshni N. Patel, MD

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