This document provides information on medications approved by the FDA to treat Alzheimer's disease (AD). It discusses drugs for mild to moderate AD like Razadyne, Exelon, and Aricept, which are cholinesterase inhibitors that prevent the breakdown of acetylcholine. It also covers Namenda for moderate to severe AD, an NMDA antagonist that regulates glutamate and delays symptom progression. Side effects are described for each drug. Testing new drugs through clinical trials is highlighted as important for finding safe and effective treatments.

1. Alzheimer’s Disease Medications
FA C T S H E E T
S
everal prescription drugs are No published study directly compares
currently approved by the U.S. these drugs. Because they work in a
Food and Drug Administration similar way, switching from one of these
(FDA) to treat people who have been drugs to another probably will not pro-
diagnosed with Alzheimer’s disease duce significantly different results.
(AD). Treating the symptoms of AD can However, an AD patient may respond
provide patients with comfort, dignity, better to one drug than another.
and independence for a longer period of
time and can encourage and assist their Treatment for Moderate
caregivers as well. to Severe AD
It is important to understand that none A medication known as Namenda®
of these medications stops the disease (memantine), an N-methyl D-aspartate
itself. (NMDA) antagonist, is prescribed to
treat moderate to severe AD. This drug’s
Treatment for Mild to main effect is to delay progression of
Moderate AD some of the symptoms of moderate to
severe AD. It may allow patients to
The medications include Razadyne®
maintain certain daily functions a little
(galantamine, formerly known as
longer than they would without the
Reminyl® and now available as a
medication. For example, Namenda®
generic drug), Exelon®(rivastigmine),
may help a patient in the later stages
and Aricept® (donepezil). Another
of AD maintain his or her ability to use
drug, Cognex® (tacrine), was the first
the bathroom independently for several
approved cholinesterase inhibitor but
more months, a benefit for both patients
is rarely prescribed today due to safety
and caregivers.
concerns.
Namenda® is believed to work by regu-
Scientists do not yet fully understand
lating glutamate, an important brain
how cholinesterase inhibitors work to
chemical. When produced in excessive
treat AD, but research indicates that
amounts, glutamate may lead to brain
they prevent the breakdown of acetyl-
cell death. Because NMDA antagonists
choline, a brain chemical believed to be
work very differently from cholinester-
important for memory and thinking. As
ase inhibitors, the two types of drugs can
AD progresses, the brain produces less
be prescribed in combination.
and less acetylcholine; therefore, cholin-
esterase inhibitors may eventually lose The FDA has also approved Aricept® for
their effect. the treatment of moderate to severe AD.
(continued on back)
Alzheimer’s Disease Education & Referral (ADEAR) Center
A Service of the National Institute on Aging
National Institutes of Health
U.S. Department of Health and Human Services

2. Medications to Treat
for professional medical advice. Consult the prescribing d
any other medications or supplements. Drugs are listed
DRUG TYPE COMMON SIDE
DRUG NAME HOW IT WORKS
AND USE EFFECTS
Namenda® N-methyl D-aspartate Blocks the toxic effects Dizziness, headache,
(memantine) (NMDA) antagonist associated with excess constipation, confusion
prescribed to treat glutamate and regulates
symptoms of moderate glutamate activation
to severe AD
Razadyne® Cholinesterase inhibitor Prevents the breakdown Nausea, vomiting,
(galantamine) prescribed to treat of acetylcholine and stimu- diarrhea, weight loss,
Also available symptoms of mild to lates nicotinic receptors to loss of appetite
as a generic moderate AD release more acetylcholine
drug in the brain
Exelon® Cholinesterase inhibitor Prevents the breakdown Nausea, vomiting,
(rivastigmine) prescribed to treat of acetylcholine and butyryl- diarrhea, weight
symptoms of mild to choline (a brain chemical loss, loss of appetite,
moderate AD similar to acetylcholine) in muscle weakness
the brain
Aricept® Cholinesterase inhibitor Prevents the breakdown Nausea, vomiting,
(donepezil) prescribed to treat of acetylcholine in the brain diarrhea
symptoms of mild
to moderate, and
moderate to severe AD

3. Alzheimer’s Disease
doctor and read the package insert before using these or
in order of FDA approval, starting with the most recent.
MANUFACTURER’S FOR MORE
RECOMMENDED DOSAGE INFORMATION
For current information about this drug’s
safety and use, visit www.namenda.com.
drug label.
above
For current information about this drug’s
day) safety and use, visit www.razadyneer.com.
see links to prescribing information.
but taken once a day
above
For current information about this drug’s
a day) safety and use, visit www.fda.gov/cder.
and click on drug-name links to see “Label
if well tolerated
capsule
For current information about this drug’s
safety and use, visit www.fda.gov/cder.
if well tolerated
and click on drug-name links to see “Label

4. (continued from front)
Dosage and Side Effects and herbal supplements. Also, let the
doctor know before adding or changing
Doctors usually start patients at low any medications.
drug doses and gradually increase the
dosage based on how well a patient
tolerates the drug. There is some evi-
dence that certain patients may benefit
from higher doses of the cholinesterase
inhibitors. However, the higher the
dose, the more likely are side effects.
The recommended effective dosages of Testing New AD Drugs
drugs prescribed to treat the symptoms
Clinical trials are the best way to find
of AD and the drugs’ possible side
out if promising new treatments are
effects are summarized in the table safe and effective in humans. Volunteer
(see inside). participants are needed for many AD
Patients should be monitored when a trials conducted around the United
drug is started. Report any unusual States. To learn more, talk with your
doctor or visit the ADEAR Center’s
symptoms to the prescribing doctor
listing of clinical trials at www.nia.nih.
right away. It is important to follow gov/Alzheimers/ResearchInformation/
the doctor’s instructions when taking Clinical Trials. More information is
any medication, including vitamins available at www.ClinicalTrials.gov.
For More Information
To learn about support groups, research to local and national resources. The
centers, research studies, and publica- ADEAR website offers free, online
tions about AD, contact the following publications in English and Spanish;
resources: email alert and online Connections news-
letter subscriptions; an AD clinical trials
Alzheimer’s Disease Education and
database; the AD Library database; and
Referral (ADEAR) Center
more.
P Box 8250
.O.
Silver Spring, MD 20907-8250 Alzheimer’s Association
800-438-4380 (toll-free) 225 North Michigan Avenue, Floor 17
www.nia.nih.gov/Alzheimers Chicago, IL 60601-7633
800-272-3900 (toll-free)
A service of the National Institute on
866-403-3073 (TDD/toll-free)
Aging (NIA), the ADEAR Center offers
www.alz.org
information and publications for families,
caregivers, and professionals on diagno- The Alzheimer’s Association is a national
sis, treatment, patient care, caregiver nonprofit association with a network of
needs, long-term care, education and local chapters that provide education and
training, and research related to AD. support for people diagnosed with AD,
Staff members answer telephone, email, their families, and caregivers. The Asso-
and written requests and make referrals ciation also supports research on AD.