Alzheimer/Dementia: Dosing and Dealing With Side Effects

March 27, 2010 at 4:13 am 6 comments

The medications used to treat dementia/Alzheimer’s can produce side effects in people that make them discontinue using them. There are certain small changes that can be done to lessen the side effects.

The first line of medications in treating this disorder is a class of drugs known as the Cholinesterase Inhibitors. These medications block the breakdown of acetylcholine, thus, increasing the amount of it in the brain. This increase in the brain should improve cognitive function.

Aricept (donepezil) is one of the cholinesterase inhibitors. It recommended to be taken at bedtime, with or without food. If the patient experiences strange dreams or nightmares, tell your physician and he will probably suggest taking the medication in the morning to lessen or avoid this side effect. The most common side effect is nausea, vomiting, diarrhea and dizziness. The starting dose is 5mg daily and if tolerated your physician will increase the medication to 10mg daily after 4-6 weeks. If upon the increase, the patient is not tolerating it well, tell the doctor because the dose may have to be decreased. If the patient is experiencing side effects with the 5mg dose, your doctor may decrease the dose to 2.5mg or lower and increase it much slower while observing how the patient tolerates it. Sometimes the total daily dose may be divided into 2 doses, 6 hours apart. It is important to remember that if side affects occur; starting with a small dose and slowly increasing the dose can help to minimize this problem.

Another medication that is also in the class of cholinesterase inhibitors is Razadyne (galantamine). If you are taking the IR form which is the immediate release form of the medication, the usual dose is 4mg twice daily. After 4 weeks it is usually increased to 8mg twice daily. The medication can be increased to 12mg twice daily after another 4 weeks, under your doctor’s supervision. The medication should be taken in the morning and evening with food and water. Some doctors prefer using Razadyne ER, which is the extended release form of the medication and is only taken once daily. Your doctor will decide which the best form is for you.

Another commonly used cholinesterase inhibitor is Exelon (rivastigmine). Exelon is available to be taken by mouth in capsule or liquid form and also available in patch form. The oral form is usually 1.5mg capsule twice daily. If tolerating it well your doctor will probably increase it slowly over 4-8 weeks to the final dose of 6mg twice daily. Take this medication with morning and evening meals. The patch can be used in place of oral medication. This can help reduce some side effects. The patch is applied daily and is started at a low dose and gradually increased. The patch should be applied to different areas daily to prevent irritation. It can be placed on the back, upper arm, or the chest. Remember not to cut the patch. The patch is very helpful with patients who are experiencing gastrointestinal side effects.

Another medication used in treatment is Namenda (memantine). Namenda’s mechanism of action is different from above medications. This medication works by blocking a receptor, thus, it can prevent over-stimulation of the receptor which can result in neuron injury and death. The manufacturer recommends starting at 5mg daily. Usually, if tolerated, an increase of 5mg per week divided into 2 doses. Meaning that by week 2, the patient is taking 5mg twice daily. The following week, the patient is taking 15mg (5mg and 10mg in 2 separate doses). Finally, if tolerated, the patient will be taking 10mg twice daily. This medication may be taken with or without food. Not all patients will be able to tolerate the increasing of dosing. Some patients will only be able to tolerate 5mg once daily. Discuss this with your doctor and decide which is best for your loved one.

Alzheimer/Dementia: Dosing and Dealing With Side Effects


Entry filed under: Alzheimer, Dementia. Tags: , , .

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6 Comments Add your own

  • 1. Amanda Rosenfeld  |  March 30, 2010 at 1:52 am

    Very useful for drug information for my rotations!!

    • 2. twicetheadvice  |  March 30, 2010 at 2:32 am

      We are so glad that we can help you in your clinical rotations!!

  • 3. Dee Feld  |  June 25, 2010 at 10:59 pm

    My mother uses the Exelon Patch, but her skin is so irritated. Do you have any suggestions on how we can make the irritation less? Thanks so much, Dee

    • 4. twicetheadvice  |  June 26, 2010 at 1:49 am

      It is recommended when using the Exelon Patch to apply it to a clean, hairless area. The skin should be healthy and should not be applied to an area that will be covered by tight clothing. A good area to apply the patch would be the upper or lower back. Other areas that are also good are the upper arm or chest. It is important to change the patch daily and do not apply to the same area for 14 days. This will prevent skin irritation. Just as you give your loved one his oral medications at the same time each day, you should change the patch at the same time each day.

  • 5. Sue  |  July 9, 2010 at 1:07 am

    My mother is taking Aricept and Namenda and has just been diagnosed with low blood pressure. Could this be a result of these 2 drugs? Thank you

    • 6. twicetheadvice  |  July 21, 2010 at 12:34 am

      Aricept and Namenda are not drugs that usually cause low blood pressure. In fact, 3% of patients on Aricept can develop high blood pressure while 4% of patients on Namenda can also develop high blood pressure. Just for your information there is a new form of Namenda, Namenda Extended Release, in which 2% of patients can develop hypotension.


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