Dementia associated with Parkinson's disease
SIGN 168: Assessment, diagnosis, care and support for people with dementia and their carers NICE NG97: Dementia Mood Café: Memory Problems
Rivastigmine patches are useful for patients who may require once daily dosing or another route of administration.
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.
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.
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.
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 donepezil, galantamine, rivastigmine or memantine on the advice of a clinician who has the necessary knowledge and skills.
- Memantine can considered for use, either as monotherapy or in combination with a cholinesterase inhibitor, in patients where other medication has not been tolerated or is contraindicated.
- 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.
- 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.
- 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.