THERAPEUTICS

Brands

• Razadyne, Razadyne ER, Reminyl

Generic?

• Yes

Class

• Cholinesterase inhibitor

Commonly Prescribed for

(FDA approved in bold)

• Alzheimer's dementia (AD) (mild or moderate)

• Dementia with Lewy bodies (DLB)

• Vascular dementia

How the Drug Works

• Increases the concentration of acetylcholine through reversible inhibition of metabolism by acetylcholinesterase enzyme, which increases availability of acetylcholine. A deficiency of cholinergic function is felt to be important in producing the signs and symptoms of AD

• May also modulate nicotine receptors thereby increasing acetylcholine release

• May interfere with amyloid deposition

• Although symptoms of AD can improve, galantamine does not prevent disease progression

How Long Until It Works

• Typically 2–6 weeks at a given dose, but effect is best observed over a period of months

If It Works

• Continue to use but symptoms of dementia usually worsen over time

If It Doesn't Work

• Consider adjusting dose

• Change to another cholinesterase inhibitor or NMDA antagonist (memantine)

• Non-pharmacological measures are the basis of dementia treatment. Maintain regular schedules and routines. Avoid prolonged travel, unnecessary medical procedures or emergency room visits, crowds, and large social gatherings

• Limit drugs with sedative properties such as opioids, hypnotics, AEDs, and TCAs

• Treat other disorders that can worsen symptoms, such as hyperglycemia or urinary difficulties

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Addition of the NMDA receptor antagonist memantine may be useful

• Treat depression or apathy with SSRIs but be cautious for increased risk of AEs (e.g., QTc prolongation, injurious falls). Avoid TCAs in demented patients due to risk of confusion. In dementia patients with severe depression, electroconvulsive therapy can be an option

• For significant confusion and agitation avoid neuroleptics (especially in DLB) because of the risk of neuroleptic malignant syndrome. Atypical antipsychotics (e.g., risperidone, clozapine, aripiprazole) or SSRIs can be used instead

Tests

• None required