Alzheimer’s disease
Medication doses are gradually titrated upwards according to response and side-effects. Further information is available in NICE NG97 Dementia: assessment, management and support for people living with dementia and their carers.
NICE NG97: Dementia Mood Café: Memory Problems SIGN 168: Assessment, diagnosis, care and support for people with dementia and their carers
Initially 5mg once daily for one month, then increased if necessary up to 10mg daily, doses to be given at bedtime.
Initially 5mg once daily for one month, then increased if necessary up to 10mg daily, doses to be given at bedtime.
Initially 5mg once daily for one month, then increased if necessary up to 10mg daily, doses to be given at bedtime.
Initially 5mg once daily for one month, then increased if necessary up to 10mg daily, doses to be given at bedtime.
Transdermal rivastigmine is an alternative to oral medication.
Initially 1.5mg twice daily to be taken with breakfast and evening meal, increased in steps of 1.5mg twice daily, dose to be increased, if tolerated and if necessary, at intervals of at least 2-4 weeks; usual dose 3-6mg twice daily; max dose 6mg twice daily.
Initially 1.5mg twice daily to be taken with breakfast and evening meal, increased in steps of 1.5mg twice daily, dose to be increased, if tolerated and if necessary, at intervals of at least 2-4 weeks; usual dose 3-6mg twice daily; max dose 6mg twice daily.
Initially 1.5mg twice daily to be taken with breakfast and evening meal, increased in steps of 1.5mg twice daily, dose to be increased, if tolerated and if necessary, at intervals of at least 2-4 weeks; usual dose 3-6mg twice daily; max dose 6mg twice daily.
Initially 1.5mg twice daily to be taken with breakfast and evening meal, increased in steps of 1.5mg twice daily, dose to be increased, if tolerated and if necessary, at intervals of at least 2-4 weeks; usual dose 3-6mg twice daily; max dose 6mg twice daily.
See BNF for dosing schedule.
See BNF for dosing schedule.
See BNF for dosing schedule.
Using modified release capsules; initially 8mg once daily for 4 weeks, increased to 16mg once daily for at least 4 weeks; maintenance 16-24mg daily.
Using modified release capsules; initially 8mg once daily for 4 weeks, increased to 16mg once daily for at least 4 weeks; maintenance 16-24mg daily.
Using modified release capsules; initially 8mg once daily for 4 weeks, increased to 16mg once daily for at least 4 weeks; maintenance 16-24mg daily.
Prescribing Notes:
- Special arrangements exist for patients with learning disability.
- Prescribers should only start treatment with donepezil, galantamine, rivastigmine or memantine on the advice of a clinician who has the necessary knowledge and skills.
- Dose titration, assessment of efficacy and tolerability, and any necessary monitoring will be undertaken by the specialist service as per local protocols and shared care agreements. If the drug has not been effective then it should be discontinued and an alternative considered instead.
- Further information is available in the NICE NG97 Dementia: assessment, management and support for people living with dementia and their carers.
- In selecting an appropriate drug for the individual patient the choice of treatment will take into account the adverse event profile, expectations about adherence, medical comorbidity, possibility of drug interactions and dosing profiles.
- Memantine may be prescribed for patients with moderate dementia in Alzheimer’s disease who are intolerant of or have a contraindication to acetylcholinesterase inhibitors.
- In case of local skin irritation with rivastigmine patches, patients may be switched to an alternative brand.
- Some of the drugs used in dementia are available in orodispersible tablets or oral solution. These formulations should be reserved for patients with swallowing difficulties.
- Rivastigmine patches may be an appropriate choice of formulation for some patients.
- Where more than one therapeutic agent and/or formulation is a suitable choice for the individual patient, choose the one with the lowest acquisition cost.
- One of the potential side effects of acetylcholinesterase inhibitors is bradycardia; it is recommended that pulse monitoring should be conducted in those patients at increased risk. For example where there is co-administration of beta-blockers or digoxin.
History Notes
27/10/2022
East Region Formulary content agreed.
Memantine can be used as monotherapy or in combination with an acetylcholinesterase inhibitor, see ‘Treatment of mild to moderate Alzheimer’s disease’ pathway for treatment choices.
Initially 5mg once daily, then increased in steps of 5mg every week; usual maintenance 20mg daily; maximum 20mg per day.
Initially 5mg once daily, then increased in steps of 5mg every week; usual maintenance 20mg daily; maximum 20mg per day.
Initially 5mg once daily, then increased in steps of 5mg every week; usual maintenance 20mg daily; maximum 20mg per day.
Initially 5mg once daily, then increased in steps of 5mg every week; usual maintenance 20mg daily; maximum 20mg per day.
Initially 5mg once daily, then increased in steps of 5mg every week; usual maintenance 20mg daily; maximum 20mg per day.
Initially 5mg once daily, then increased in steps of 5mg every week; usual maintenance 20mg daily; maximum 20mg per day.
Prescribing Notes:
- Special arrangements exist for patients with learning disability.
- Prescribers should only start treatment with memantine on the advice of a clinician who has the necessary knowledge and skills.
- Dose titration, assessment of efficacy and tolerability, and any necessary monitoring will be undertaken by the specialist service as per local protocols and shared care agreements. If the drug has not been effective then it should be discontinued and an alternative considered instead.
- In selecting an appropriate drug for the individual patient the choice of treatment will take into account the adverse event profile, expectations about adherence, medical comorbidity, possibility of drug interactions and dosing profiles.
History Notes
27/10/2022
East Region Formulary content agreed.