• 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

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 5mg (specialist initiation/recommendation)

Dosage:

Doses to be given at bedtime.

Important: 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

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

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

Important: Formulation and dosage details

Formulation:

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

RIVASTIGMINE

Important: Therapy notes

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

Important: Formulation and dosage details

Formulation:

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

Important: Formulation and dosage details

Formulation:

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

Important: 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

Important: 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.

Important: Formulation and dosage details

Formulation:

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

Important: Formulation and dosage details

Formulation:

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

Document Id: F081