Drugs used for Alzheimer's disease

Drug class

Adverse effects

Key points

Acetylcholinesterase inhibitors
(eg, donepezil, rivastigmine, galantamine)

• Nausea, vomiting
• Diarrhea

• Titrate slowly (eg, every 6 weeks)
• Take donepezil at bedtime

• Bradycardia
• Donepezil: QT prolongation

• Use caution with drugs that decrease heart rate (eg, beta-blockers)

• Insomnia

• Change donepezil to morning administration

NMDA inhibitor
(eg, memantine)

• Dizziness, confusion, headache

• ER capsules can be opened & sprinkled on applesauce
• Namzaric (donepezil/memantine): only for patients stabilized on donepezil 10 mg daily*

Amyloid beta monoclonal antibodies
(eg, aducanumab, lecanemab)

• Infusion-related reactions
• Amyloid-related imaging abnormalities (ARIA)

• IV only
• Role in treatment not yet well defined

*All strengths of Namzaric contain donepezil 10 mg; donepezil requires titration from a starting dose of 5 mg to avoid gastrointestinal adverse effects.

ER = extended release; NMDA = N-methyl-D-aspartate.