Donepezil (Aricept, Eisai/Pfizer) is an AChE inhibitor, which works by increasing the concentration of acetylcholine at sites of neurotransmission. Donepezil has a marketing authorisation in the UK for the symptomatic treatment of mild to moderately severe Alzheimer's dementia. It is given initially at 5 mg once daily at bedtime. After 1 month the treatment should be assessed, and the dose can be increased to a maximum of 10 mg once daily if necessary.
Common undesirable effects include diarrhoea, muscle cramps, fatigue, nausea, vomiting and insomnia. For full details of side effects and contraindications, see the summaries of product characteristics.
Donepezil is available as tablets and orodispersible tablets. Net prices are stated. The cost of tablets is £59.85 (5 mg, 28-tablet pack) and £83.89 (10 mg, 28-tablet pack). The cost of orodispersible tablets is £59.85 (5 mg, 28-tablet pack) and £83.89 (10 mg, 28-tablet pack; 'BNF, edition 60). Costs may vary in different settings because of negotiated procurement discounts.
Galantamine (Reminyl, Shire) is an AChE inhibitor, which works by increasing the concentration of acetylcholine at sites of neurotransmission and also modulates activity at nicotinic receptors. Galantamine has a marketing authorisation in the UK for the symptomatic treatment of mild to moderately severe dementia of the Alzheimer's type. The formulation given most frequently is a capsule given initially at 8 mg once daily for 4 weeks and then increased to 16 mg once daily for at least 4 weeks. Maintenance treatment is 16 to 24 mg once daily depending on assessment of clinical benefit and tolerability. An older tablet formulation and a liquid preparation are also available to be given twice a day, see the summaries of product characteristics for more information.
Common undesirable effects include nausea and vomiting. For full details of side effects and contraindications, see the summaries of product characteristics.
Galantamine is available as tablets, oral solution and capsules. Net prices are stated. The cost of tablets is £68.32 (8 mg, 56-tablet pack) and £84.00 (12 mg, 56-tablet pack). Oral solution (4 mg/ml, 100 ml) costs £120.00. Modified release capsules cost £51.88 (8 mg, 28-capsule pack), £64.90 (16 mg, 28-capsule pack) and £79.80 (24 mg, 28-capsule pack; BNF, edition 60). Costs may vary in different settings because of negotiated procurement discounts.
Rivastigmine (Exelon, Novartis) is an AChE inhibitor, which works by increasing the concentration of acetylcholine at sites of neurotransmission. Rivastigmine has a marketing authorisation in the UK for the symptomatic treatment of mild to moderately severe Alzheimer's dementia. The dose is initially 1.5 mg twice daily and may be increased in steps of 1.5 mg twice daily at intervals of at least 2 weeks according to tolerance up to a maximum dose of 6 mg twice daily. Alternatively, rivastigmine patches are available, initially using a 4.6-mg patch per day. This can be increased to a 9.5-mg patch per day for at least 4 weeks. See the summary of product characteristics for further information on using patches.
Common undesirable effects are mainly gastrointestinal including nausea and vomiting. For full details of side effects and contraindications, see the summaries of product characteristics.
Rivastigmine is available as capsules, oral solution and patches. Net prices are stated. The cost of 1.5 mg rivastigmine capsules is £33.25 (28-capsule pack) and £66.51 (56-capsule pack); 3 mg capsules cost £33.25 (28-capsule pack) and £66.51 (56-capsule pack); 4.5 mg capsules cost £33.25 (28-capsule pack) and £66.51 (56-capsule pack); 6 mg capsules cost £33.25 (28-capsule pack) and £66.51 (56-capsule pack). Oral solution costs £99.14 (2 mg/ml, 120 ml). Patches cost £77.97 (4.6 mg/24 hours, 30 patches) and £77.97 (9.5 mg/24 hours, 30 patches; BNF, edition 60). Costs may vary in different settings because of negotiated procurement discounts.
Memantine (Ebixa, Lundbeck) is a voltage-dependent, moderate-affinity, uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist that blocks the effects of pathologically elevated tonic levels of glutamate that may lead to neuronal dysfunction. It has a marketing authorisation in the UK for the treatment of patients with moderate to severe Alzheimer's disease. Memantine is initially given as 5 mg once daily and then increased in steps of 5 mg at weekly intervals to a maximum of 20 mg daily.
Common undesirable effects are dizziness, headache, constipation, somnolence and hypertension. For full details of side effects and contraindications, see the summaries of product characteristics.
Memantine is available as tablets and oral drops. Net prices are stated. 10 mg memantine tablets cost £34.50 (28-tablet pack), £69.01 (56-tablet pack) and £138.01 (112-tablet pack). 20 mg tablets cost £69.01 (28-tablet pack). A treatment initiation pack (7×5 mg, 7×10 mg, 7×15 mg, and 7×20 mg tablets) costs £43.13. Oral drops (10 mg/g) cost £61.61 for 50 g and £123.23 for 100 g (BNF, edition 60). Costs may vary in different settings because of negotiated procurement discounts.