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The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medicines only as recommended by your doctor, and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

There are no medicines to cure Alzheimer’s disease, but certain medicines are commonly prescribed to manage the symptoms. Other medicines are under investigation in clinical trials.

Prescription Medications
Over-the-Counter Medications

Cholinesterase inhibitors most commonly prescribed for Alzheimer’s disease include:

  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Reminyl)

Cholinesterase inhibitors help enhance memory and other cognitive functions. This type of medication slows the breakdown of a chemical that helps cells communicate with one another. The longer this chemical exists the better the communication between brain cells. This may help to slow disease progression somewhat in people with mild to moderate Alzheimer's disease.

Depending on which cholinesterase inhibitor you take, possible side effects include:

  • Nausea, vomiting
  • Diarrhea
  • Stomach pain or cramping
  • Slowing of heart rate
  • Fainting spells
  • Headache
  • Loss of appetite
  • Increased frequency of bowel movements
  • Liver problems (especially with tacrine)
  • Rashes
  • Dizziness
  • Nasal discharge
  • Facial flushing
Glutamate Blockers

Memantine (Namenda) is a newer type of medicine. It blocks the effects of a chemical that is believed to be toxic to nerve cells. Memantine is the first drug approved for treatment of moderate to severe Alzheimer’s disease. Improvements in daily functioning and cognition (thinking) have been seen. Memantine should not be used if you have severe kidney impairment.

Possible side effects of memantine include:

At least 25% of people with Alzheimer’s disease have depression. Antidepressants are used to treat low mood, depression, anxiety, and irritability. The antidepressants prescribed for Alzheimer’s disease belong to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). SSRIs work by increasing the activity of the chemical serotonin in the brain.

Selective serotonin reuptake inhibitors (SSRIs) prescribed for Alzheimer’s disease include:

  • Citalopram (Celexa)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Possible side effects of SSRIs include:

  • Drowsiness
  • Dryness of mouth
  • Blurred vision
  • Nausea
  • Dizziness
  • Weight gain
  • Difficulty sleeping
  • Sexual dysfunction
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients

Anti-anxiety medicines (anxiolytics) help ease symptoms of anxiety, phobias, and excessive motor activity. The medicines listed are in a class of medicines called benzodiazepines. Benzodiazepines reduce symptoms of anxiety by enhancing the function of gamma aminobutyric acid (GABA). These drugs produce a sedative effect, decrease physical symptoms, such as muscle tension, and often cause drowsiness and lethargy. They can be habit-forming when used long term or in excess. These drugs should not be used more than prescribed since they may cause or worsen problems with memory. These drugs should also not be stopped abruptly since serious side effects, such as seizures, may result.

Benzodiazepines sometimes prescribed for Alzheimer’s disease include:

  • Lorazepam (Ativan)
  • Oxazepam (Serax)

Possible side effects of benzodiazepines include:

  • Drowsiness
  • Dizziness
  • Confusion
  • Weakness
  • Difficulty walking
  • Respiratory depression (decreasing breathing)

Antipsychotic medicines are used for symptoms of agitation, hallucinations, delusions, bizarre behavior, and violent behavior. These drugs usually have a sedating effect on behavior and may not always be effective for patients with Alzheimer’s disease.

Antipsychotics sometimes prescribed for Alzheimer’s disease include:

  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)

Possible side effects of olanzapine include:

  • Agitation
  • Behavior problems
  • Difficulty in speaking or swallowing
  • Restlessness or need to keep moving
  • Stiffness of arms or legs
  • Trembling or shaking of hands and fingers

Possible side effects of risperidone and quetiapine include:

  • Tardive dyskinesia (fine, worm-like movements of the tongue, or other uncontrolled movements of the mouth, tongue, cheeks, jaw, shoulders, arms, or legs)

In some cases these side effects are not reversible.

The antioxidant vitamin E has been studied in combination with selegiline (Eldepryl), a medicine used to treat Parkinson’s disease, for possible protective effects against the progression of Alzheimer’s disease. Vitamin E is an antioxidant and may help prevent brain cell damage.

It is not clear that vitamin E provides any benefit. Further research is needed to conclusively determine the potential benefits of vitamin E in Alzheimer’s disease. Some doctors are recommending vitamin E as a potential preventive measure. However, since vitamin E can increase the risk of bleeding when taken with other medicines, such as aspirin or warfarin (a blood thinning medicine), you should talk with your doctor before beginning it.

If you are taking medicines, follow these general guidelines:

  • Take your medicine as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Ask what results and side effects to expect. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicine and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.
References:

Alzheimer's disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 11, 2012. Accessed August 22, 2012.

Treatments for Alzheimers. Alzheimer’s Association website. Available at: http://www.alz.org/. Accessed August 22, 2012.

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Published May 22, 2009. Accessed August 22, 2012.

Burns A. Alzheimer’s disease: on the verges of treatment and prevention. Lancet Neurology. 2009;8:4-5.

Kamat CD, Gadal S, Mhatre M, et al. Antioxidants in central nervous system diseases: preclinical promise and translational challenges. J Alzheimers Dis. 2008;15(3):473-493.

Neogroschul J, Sano M. Current treatment and recent clinical research in Alzheimer’s disease. Mt Sinai J Med. 2010;77(1):3-16.

United States Pharmacopeial Convention. USP DI. 21st ed. Englewood, CO: Micromedex; 2001.

Von Arnim CA, et al. Dietary antioxidants and dementia in a population-based case-control study among older people in South Germany. J Alzheimers Dis. 2012.

2/18/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

Last reviewed September 2013 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


 
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