Dementia medication (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland
  • The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine, as monotherapies, are recommended as options for managing mild to moderate Alzheimer's disease.
  • Memantine monotherapy is recommended as an option for managing Alzheimer's disease for people with:
    • Moderate Alzheimer's disease who are intolerant of or have a contraindication to AChE inhibitors or
    • Severe Alzheimer's disease.
  • For people with an established diagnosis of Alzheimer's disease who are already taking an AChE inhibitor:
    • Consider memantine in addition to an AChE inhibitor if they have moderate disease
    • Offer memantine in addition to an AChE inhibitor if they have severe disease.
  • Treatment should be under the following conditions:
    • For people who are not taking an AChE inhibitor or memantine, prescribers should only start treatment with these on the advice of the older adult psychiatric team
    • For people with an established diagnosis of Alzheimer's disease who are already taking an AChE inhibitor, primary care prescribers may start treatment with memantine without taking advice from a specialist clinician.
    • Do not stop AChE inhibitors in people with Alzheimer's disease because of disease severity alone
  • For further information see AChEI and memantine in dementia guideline.

DONEPEZIL

Therapy notes

Formulation and dosage details

Formulation:

Tablets 5mg (specialist initiation/recommendation)

Dosage:

Doses to be given at bedtime.

Formulation and dosage details

Formulation:

Orodispersible tablets 5mg, 10mg (specialist initiation/recommendation)

Dosage:

Doses to be given at bedtime.

The orodispersible tablet should be placed on the tongue, allow to disperse, and swallow.

GALANTAMINE

Therapy notes

Formulation and dosage details

Formulation:

Modified release capsules 8mg, 16mg, 24mg (specialist initiation/recommendation)

Formulation and dosage details

Formulation:

Oral solution 4mg/mL (specialist initiation/recommendation)

RIVASTIGMINE

Therapy notes

MHRA advice: Rivastigmine (Exelon) transdermal patch: risk of medication errors (December 2014) (www.gov.uk).
Risk minimisation materials

Formulation and dosage details

Formulation:

Capsules 1·5mg, 3mg, 4·5mg, 6mg (specialist initiation/recommendation)

Formulation and dosage details

Formulation:

Oral solution 2mg/mL (specialist initiation/recommendation)

Formulation and dosage details

Formulation:

Transdermal patch 4·6mg/24hours, 9·5mg/24 hours (specialist initiation/recommendation)

Dosage:

If switching a patient from oral to transdermal therapy refer to BNF.

MEMANTINE

Therapy notes

  • Memantine is an alternative treatment recommended in moderate Alzheimer’s disease where the cholinesterase inhibitors cannot be used. It is also recommended as an option in severe Alzheimer’s disease.

Formulation and dosage details

Formulation:

Tablets 10mg, 20mg (specialist initiation/recommendation)

Formulation and dosage details

Formulation:

Oral solution 5mg/actuation (10mg/mL) (specialist initiation/recommendation)

Editorial Information

Document Id: F081