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Treatment of Alzheimer’s Disease

How Is Alzheimer's Disease Treated?

Alzheimer’s disease is complex, and it is unlikely that any one drug or other intervention will successfully treat it. Current approaches focus on helping people maintain mental function, manage behavioral symptoms, and slow or delay the symptoms of disease.Older woman and her doctor having a serious conversation

Several prescription drugs are currently approved by the U.S. Food and Drug Administration (FDA) to treat people who have been diagnosed with Alzheimer’s disease. Treating the symptoms of Alzheimer’s can provide patients with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well.

Most medicines work best for people in the early or middle stages of Alzheimer’s. For example, they can keep memory loss from getting worse over time. It is important to understand that none of these medications stops the disease itself.

Treatment for Mild to Moderate Alzheimer’s

Medications called cholinesterase inhibitors are prescribed for mild to moderate Alzheimer’s disease. These drugs may help delay or prevent symptoms from becoming worse for a limited time and may help control some behavioral symptoms. The medications are Razadyne® (galantamine), Exelon® (rivastigmine), and Aricept® (donepezil).

Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimer’s disease, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimer’s progresses, the brain produces less and less acetylcholine; therefore, cholinesterase inhibitors may eventually lose their effect.

No published study directly compares these drugs. Because they work in a similar way, switching from one of these drugs to another probably will not produce significantly different results. However, an Alzheimer’s patient may respond better to one drug than another.

Treatment for Moderate to Severe Alzheimer’s

A medication known as Namenda® (memantine), an N-methyl D-aspartate (NMDA) antagonist, is prescribed to treat moderate to severe Alzheimer’s disease. This drug’s main effect is to delay progression of some of the symptoms of moderate to severe Alzheimer’s. It may allow patients to maintain certain daily functions a little longer than they would without the medication. For example, Namenda® may help a patient in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both patients and caregivers.

The FDA has also approved Aricept® and Namzaric®, a combination of Namenda® and Aricept®, for the treatment of moderate to severe Alzheimer’s disease.

Namenda® is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work very differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.

Drug Name

Drug Type and Use

How It Works

Common Side Effects

Aricept® (donepezil)
Cholinesterase inhibitor prescribed to treat symptoms of mild, moderate, and severe Alzheimer's Prevents the breakdown of acetylcholine in the brain Nausea, vomiting, diarrhea, muscle cramps, fatigue, weight loss
Exelon® (rivastigmine)
Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's (patch is also for severe Alzheimer's) Prevents the breakdown of acetylcholine and butyrylcholine (a brain chemical similar to acetylcholine) in the brain Nausea, vomiting, diarrhea, weight loss, indigestion, muscle weakness
Namenda® (memantine)
N-methyl D-aspartate (NMDA) antagonist prescribed to treat symptoms of moderate to severe Alzheimer's Blocks the toxic effects associated with excess glutamate and regulates glutamate activation Dizziness, headache, diarrhea, constipation, confusion
Namzaric® (memantine extended-release and donepezil)
NMDA antagonist and cholinesterase inhibitor prescribed to treat symptoms of moderate to severe Alzheimer’s (for patients stabilized on both memantine and donepezil taken separately) Blocks the toxic effects associated with excess glutamate and prevents the breakdown of acetylcholine in the brain Headache, nausea, vomiting, diarrhea, dizziness
Razadyne® (galantamine)
Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's Prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain Nausea, vomiting, diarrhea, decreased appetite, dizziness, headache

Drug Name

Manufacturer's Recommended Dosage

For More Information

Aricept® (donepezil)
  • Tablet*: Initial dose of 5 mg once a day
  • May increase dose to 10 mg/day after 4-6 weeks if well tolerated, then to 23 mg/day after at least 3 months
  • Orally disintegrating tablet*: Same dosage as above
  • 23-mg dose available as brand-name tablet only
For current information about this drug's safety and use, visit www.aricept.com/prescribing-and-patient-info.
Exelon® (rivastigmine)
  • Capsule*: Initial dose of 3 mg/day (1.5 mg twice a day)
  • May increase dose to 6 mg/day (3 mg twice a day), 9 mg (4.5 mg twice a day), and 12 mg/day (6 mg twice a day) at minimum 2-week intervals if well tolerated
  • Patch*: Initial dose of 4.6 mg once a day; may increase dose to 9.5 mg once a day and 13.3 mg once a day at minimum 4-week intervals if well tolerated
For current information about this drug’s safety and use, visit the www.fda.gov/Drugs. Click on "Drugs @ FDA," search for Exelon, and click on drug-name links to see "Label Information."
Namenda® (memantine)
  • Tablet*: Initial dose of 5 mg once a day
  • May increase dose to 10 mg/day (5 mg twice a day), 15 mg/day (5 mg and 10 mg as separate doses), and 20 mg/day (10 mg twice a day) at minimum 1-week intervals if well tolerated
  • Oral solution*: Same dosage as above
  • Extended-release capsule: Initial dose of 7 mg once a day; may increase dose to 14 mg/day, 21 mg/day, and 28 mg/day at minimum 1-week intervals if well tolerated
For current information about this drug's safety and use, visit www.namenda.com and www.namendaxr.com. See "Full Prescribing Information."
Namzaric® (memantine extended-release and donepezil)
  • Capsule: 28 mg memantine extended-release + 10 mg donepezil once a day
  • 14 mg memantine extended-release + 10 mg donepezil once a day (for patients with severe renal impairment)

For current information about this drug’s safety and use, visit www.namzaric.com. Click on “Full Prescribing Information” to see the drug label.

Razadyne® (galantamine)
  • Tablet*: Initial dose of 8 mg/day (4 mg twice a day)
  • May increase dose to 16 mg/day (8 mg twice a day) and 24 mg/day (12 mg twice a day) at minimum 4-week intervals if well tolerated
  • Extended-release capsule*: Same dosage as above but taken once a day
For current information about this drug’s safety and use, visit www.janssenmd.com/razadyne. Click on "full Prescribing Information" to see the drug label.

* Available as a generic drug.

Dosage and Side Effects

Doctors usually start patients at low drug doses and gradually increase the dosage based on how well a patient tolerates the drug. There is some evidence that certain patients may benefit from higher doses of the cholinesterase inhibitors. However, the higher the dose, the more likely side effects are to occur.

Patients should be monitored when a drug is started. All of these medicines have possible side effects, including nausea, vomiting, diarrhea, and loss of appetite. Report any unusual symptoms to the prescribing doctor right away. It is important to follow the doctor’s instructions when taking any medication, including vitamins and herbal supplements. Also, let the doctor know before adding or changing any medications.

Managing Behavior

Common behavioral symptoms of Alzheimer’s include sleeplessness, wandering, agitation, anxiety, aggression, restlessness, and depression. Scientists are learning why these symptoms occur and are studying new treatments—drug and nondrug—to manage them. Research has shown that treating behavioral symptoms can make people with Alzheimer’s more comfortable and makes things easier for caregivers.

Examples of medicines used to help with depression, aggression, restlessness, and anxiety include:

  • Celexa® (citalopram)
  • Remeron® (mirtazapine)
  • Zoloft® (sertraline)
  • Wellbutrin® (bupropion)
  • Cymbalta® (duloxetine)
  • Tofranil® (imipramine)

Experts agree that medicines to treat these behavior problems should be used only after other strategies that don’t use medicine have been tried.

Medicines to be Used with Caution

There are some medicines, such as sleep aids, anti-anxiety drugs, anticonvulsants, and antipsychotics, that a person with Alzheimer’s disease should take only:

  • After the doctor has explained all the risks and side effects of the medicine
  • After other, safer non-medication options have not helped treat the problem

You will need to watch closely for side effects from these medications.

Sleep aids are used to help people get to sleep and stay asleep. People with Alzheimer’s disease should NOT use these drugs regularly because they make the person more confused and more likely to fall. Examples of these medicines include:

  • Ambien® (zolpidem)
  • Lunesta® (eszopiclone)
  • Sonata® (zaleplon)

Anti-anxiety drugs are used to treat agitation. These drugs can cause sleepiness, dizziness, falls, and confusion. For this reason, doctors recommend using them only for short periods of time. Examples of these medicines include:

  • Ativan® (lorazepam)
  • Klonopin® (clonazepam)

Anticonvulsants are drugs sometimes used to treat severe aggression. Side effects may cause sleepiness, dizziness, mood swings, and confusion. Examples of these medicines include:

  • Depakote® (sodium valproate)
  • Tegretol® (carbamazepine)
  • Trileptal® (oxcarbazepine)

Antipsychotics are drugs used to treat paranoia, hallucinations, agitation, and aggression. Side effects of using these drugs can be serious, including increased risk of death in some older people with dementia. They should only be given to people with Alzheimer’s disease when the doctor agrees that the symptoms are severe. Examples of these medicines include:

  • Risperdal® (risperidone)
  • Seroquel® (quetiapine)
  • Zyprexa® (olanzapine)

Looking for New Treatments

Alzheimer’s disease research has developed to a point where scientists can look beyond treating symptoms to think about addressing underlying disease processes. In ongoing clinical trials, scientists are developing and testing several possible interventions, including immunization therapy, drug therapies, cognitive training, physical activity, and treatments for cardiovascular disease and diabetes.

Learn more about Alzheimer's disease from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Treating Alzheimer's

Alzheimer's Association
1-800-272-3900 (toll-free, 24/7) 
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

Alzheimer's Foundation of America
1-866-232-8484 (toll-free)
info@alzfdn.org
www.alzfdn.org

Eldercare Locator
1-800-677-1116 (toll-free)
www.eldercare.gov

If you are interested in learning more about Alzheimer's & Dementia, please call us at 1-800-438-4380, Mon-Fri, 8:30 am-5:00 pm Eastern Time or send an email to adear@nia.nih.gov