The table below provides a nice summary of the Alzheimer’s medications that have been discussed.
Brand Name |
Namenda® |
Razadyne® and Razadyne® ER (previously known as Reminyl®) |
Exelon® |
Aricept® |
Generic Name
|
memantine hydrochloride |
galantamine hydrobromide |
rivastigmine
tartrate |
donepezil hydrochloride |
Alzheimer’s Disease Stage for Use |
moderate to severe |
mild to moderate |
mild to moderate |
mild to moderate |
Mechanism of Action |
NMDA receptor antagonist: blocks the negative effects of the important chemical in the brain, called glutamate. In the later stages of Alzheimer’s disease, too much glutamate can damage areas of the brain important for learning and memory |
Cholinesterase Inhibitor: blocks the enzyme in the brain, acetylcholinesterase, from breaking down acetylcholine |
Cholinesterase Inhibitor:blocks the enzyme in the brain, acetylcholinesterase, from breaking down acetylcholine |
Cholinesterase Inhibitor: blocks the enzyme in the brain, acetylcholinesterase, from breaking down acetylcholine |
Available Dosage Forms |
5 mg tablets
10 mg tablets |
Razadyne
4 mg tablets
8 mg tablets
12 mg tablets
4 mg/mL oral solution
Razadyne ER
(extended-release)
8 mg capsules
16 mg capsules
24 mg capsules |
1.5 mg capsules
3 mg capsules
4.5 mg capsules
6 mg capsules |
5 mg tablets
10 mg tablets |
Dosing Frequency |
twice a day |
Razadyne
twice a day
Razadyne ER
(extended-release)
once a day |
twice a day |
once a day |
Starting Dose |
5 mg once a day |
Razadyne
4 mg twice daily
Razadyne ER
(extended-release)
8 mg once daily |
1.5 mg twice daily |
5 mg once daily |
Dose Escalation (titration) |
The starting dose is increased in 5-mg steps to 10 mg daily (given as 5 mg twice daily), then 15 mg a day (given in two separate doses of 10 mg and 5 mg), to the final dose of 10 mg twice daily; each dose increase is done with a minimum of 1-week in between |
Razadyne
After at least 4 weeks on the starting dose (4 mg twice daily), the dose is increased to 8 mg twice daily; after at least another 4 weeks, the dose may be increased to 12 mg twice daily
Razadyne ER
(extended-release)
After at least 4 weeks on the starting dose (8 mg a day), the dose is increased to 16 mg a day; after at least another 4 weeks, the dose may be increased to 24 mg a day |
After at least 2 weeks at the starting dose (1.5 mg twice daily), the dose is increased to 3 mg twice daily; further dose increases of 4.5 mg and 6 mg twice daily may be done after waiting 2 weeks between each previous dose |
After 4-6 weeks, the dose may be increased from 5 mg to 10 mg once a day |
Recommended Effective Dose (Maintenance Dose) |
20 mg/day |
Razadyne
16 to 24 mg/day
Razadyne ER
(extended-release)
16 to-24 mg/day |
6 to 12 mg/day |
5 to 10 mg/day |
Effect of Food |
Can be taken with or without food |
Can take with or without food, but food will help reduce side effects |
Should be taken with food |
Can take with or without food |
Common Side Effects |
Dizziness
Headache
Constipation
Confusion |
Nausea
Vomiting
Diarrhea
Loss of Appetite
Weight Loss |
Nausea*
Vomiting*
Loss of Appetite*
Dizziness
Headache
Stomach Pain
*Exelon comes with bold warnings for significant and sometimes severe nausea, vomiting and weight loss in their patients that have tried it. |
Nausea
Diarrhea
Insomnia
Fatigue
Vomiting
Loss of Appetite |
|
