Alzheimer’s Dementia Treatment

ALZHEIMER’S DEMENTIA TREATMENTS
Generic Brand Strength Form Dose
CHOLINESTERASE INHIBITORS
donepezil Aricept 5mg, 10mg, 23mg tabs Mild-moderate: Initially 5mg daily at bedtime, may increase to max 10mg daily after 4−6wks; usual dose: 5mg or 10mg once daily
Moderate-severe: Initially 5mg daily at bedtime, may increase to 10mg daily after 4−6wks; may further increase to max 23mg daily after 3mos; usual dose: 10mg or 23mg once daily.
Aricept ODT 5mg, 10mg ODT
galanta
mine
4mg/mL soln Mild‑moderate: Give with AM & PM meals. Initially 4mg twice daily; if well-tolerated, increase to maintenance dose 8mg twice daily (16mg/day) after minimum of 4wks; may attempt further increase to 12mg twice daily (24mg/day) after minimum of 4wks. Re‑titrate if interrupted for >3 days. Moderate hepatic or renal impairment (CrCl 9−59mL/min): usual max 16mg/day.
Razadyne 4mg, 8mg, 12mgL tabs
Razadyne ER 8mg, 16mg, 24mg ext-rel caps Mild‑moderate: Give with AM meal. Initially 8mg/day; if well-tolerated, increase to maintenance dose 16mg/day after minimum of 4wks; may attempt further increase to max 24mg/day after minimum of 4wks. Re‑titrate if interrupted for >3 days. Moderate hepatic or renal impairment (CrCl 9−59mL/min): usual max 16mg/day.
rivastig
mine
Exelon 1.5mg, 3mg, 4.5mg, 6mg caps Mild‑moderate: Take with food in the AM and PM. Initially 1.5mg twice daily; if well-tolerated, may increase by 1.5mg twice daily at intervals of at least 2wks. Usual range: 6−12mg/day; max 12mg/day. If dose is not tolerated, suspend for several doses and restart at same or next lower dose. If stopped for >3 days, restart at 1.5mg twice daily and retitrate. Renal or mild-to-moderate hepatic impairment: use lower doses. Low body wt. (<50kg): monitor for toxicities and consider reducing dose.
4.6mg/
 
24hrs, 9.5mg/
 
24hrs, 13.3mg/
 
24hrs
patch Initially apply one 4.6mg/24hrs patch once daily; if tolerated, may increase to 9.5mg/24hrs patch after 4wks at previous dose; can further be increased to max 13.3mg/24hrs dose. Mild-moderate: usually 9.5mg/24hrs or 13.3mg/24hrs once daily. Severe: usually 13.3mg/24hrs once daily. If dosing interrupted for >3 days, restart with 4.6mg/24hrs patch and titrate again. Mild-to-moderate hepatic impairment: initial and max dose 4.6mg/24hrs patch. Low body wt. (<50kg): monitor for toxicities and consider reducing maintenance dose to 4.6mg/24hr patch.
N-METHYL-D-ASPARTATE RECEPTOR ANTAGONIST
memantine 2mg/mL soln Moderate‑severe: Initially 5mg once daily; titrate at intervals of at least 1wk to 5mg twice daily, then to 5mg and 10mg as separate doses, then to 10mg twice daily (prescribe Titration Pak for 1st 4wks). Severe renal impairment (CrCl 5−29mL/min): titrate to max 5mg twice daily.
Namenda 5mg, 10mg tabs
Namenda XR 7mg, 14mg, 21mg, 28mg ext-rel caps Moderate‑severe: Initially 7mg once daily; titrate at intervals of at least 1wk in increments of 7mg to target dose of 28mg once daily. Max 28mg once daily. Severe renal impairment (CrCl 5−29mL/min): titrate to target dose of 14mg/day.
NMDA RECEPTOR ANTAGONIST + ACETYLCHOLINESTERASE INHIBITOR
memantine
extended-
release/
donepezil
Namzaric 7mg/
 
10mg, 14mg/
 
10mg, 21mg/
 
10mg, 28mg/
 
10mg
caps Moderate‑to-severe: Start the day after last dose of memantine and donepezil given separately. Patients stabilized on donepezil 10mg: initially 7mg/10mg once daily in the PM; increase at minimum weekly intervals in 7mg increments of memantine to max 28mg/10mg once daily; severe renal impairment (CrCl 5–29mL/min): initially 7mg/10mg once daily in the PM; increase to 14mg/10mg once daily after one week. Patients stabilized on both components: 28mg/10mg once daily in the PM; severe renal impairment (CrCl 5–29mL/min): 14mg/10mg once daily.
NOTES

Key: ext-rel caps = extended-release capsules; ODT = orally-disintegrating tablets
Not an inclusive list of medications, indications, or doses. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

(Rev. 12/2018)