THERAPEUTICS

Brands

• Aricept
• Memac
• see index for additional brand names

Generic?

• No

Class

• Cholinesterase inhibitor (selective acetylcholinesterase inhibitor); cognitive enhancer

Commonly Prescribed For

• (bold for FDA approved)
• Alzheimer disease (mild, moderate, and severe)
• Memory disorders in other conditions
• Mild cognitive impairment

How The Drug Works

• Reversibly but noncompetitively inhibits centrally-active acetylcholinesterase (AChE), making more acetylcholine available
• Increased availability of acetylcholine compensates in part for degenerating cholinergic neurons in neocortex that regulate memory
• Does not inhibit butyrylcholinesterase
• May release growth factors or interfere with amyloid deposition

How Long Until It Works

• May take up to 6 weeks before any improvement in baseline memory or behavior is evident
• May take months before any stabilization in degenerative course is evident

If It Works

• May improve symptoms and slow progression of disease, but does not reverse the degenerative process

If It Doesn’t Work

• Consider adjusting dose, switching to a different cholinesterase inhibitor or adding an appropriate augmenting agent
• Reconsider diagnosis and rule out other conditions such as depression or a dementia other than Alzheimer disease

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Atypical antipsychotics to reduce behavioral disturbances
• Antidepressants if concomitant depression, apathy, or lack of interest
• Memantine for moderate to severe Alzheimer disease
• Divalproex, carbamazepine, or oxcarbazepine for behavioral disturbances
• Not rational to combine with another cholinesterase inhibitor

Tests

• None for healthy individuals