AriceptAricept,also known as donepezil, was the second drug approved by the FDA for Alzheimer therapy. The drug is marketed in the USA by Pfizer-Eisai. The drug inhibits the breakdown of acetylcholine by acetylcholinesterase. It is useful in mild to moderate Alzheimer's. The initial dose is 5 milligrams, taken in the evening or prior to retiring. After one month of clinical monitoring, the dose may be increased to 10 milligrams daily. The drug is generally well tolerated. Dose-dependent side effects include nausea,diarrhea, muscle cramps, fatigue, insomnia. The drug does not seem to be toxic to the liver. Some cases of hallucinations,agitation, or vivid dreams have been reported. Aricept does not alter the clearance of warfarin,digoxin, or theophylline. Fluoxetine, erythromycin,and phenytoin can alter the metabolism of aricept.RivastigmineRivastigmine, also known as Exelon, is a novel "pseudoirreversible" inhibitor of acetylcholinesterase in brain. The action results in prolonged inhibition of acetylcholinesterase after the drug has been cleared from blood. Therapy requires careful monitoring of intake by the patient's physician and caregiver. The initial dose is generally 1.5 milligrams twice a day. If this dose is well-tolerated, the dose may be increased to 3-6 milligrams twice a day. The maximum recommended dose is 6 milligrams twice a day. Side effects are usually mild and appear during the escalation phase of treatment. The most common side effects are nausea, vomiting, diarrhea, abdominal pain,loss of appetite and weight loss. Exelon does not seem to interact with warfarin,digoxin,diazepam, or fluoxetine in healthy volunteers. Rivastigmine may increase the effect of succinylcholine muscle relaxants during surgical anaesthesia. The drug is most useful in mild to moderate Alzheimer's disease. The drug is taken with food. The capsules should not be opened or crushed. The drug is usually given at breakfast and then again at the evening meal. Novartis manufactures and produces Exelon.ReminylReminyl, also known as galantamine hydrobromide, is extracted from the bulbs of the daffodil, Narcissus pseudonarcissus. It was approved by the FDA as a treatment for alzheimer's disease February 28, 2001. The drug has been shown to be effective in mild to moderate stages of the disease. Reminyl is a reversible acetylcholinesterase inhibitor. Reminyl is available in 4, 8, and 12 milligram tablets. Reminyl is usually started at 4 milligrams twice a day. After a minimum of 4 weeks of treatment,if this dose is tolerated, the dose may be increased to 8 milligrams twice daily. A further increase to 12 milligrams twice daily may be attempted after a minimum of 4 weeks at the previous dose. In clinical trials, clinically significant effects on cognition have been seen at daily doses between 16 and 32 milligrams daily. Reminyl does interact with other drugs. Reminyl has the potential to interfere with the activity of anticholinergic drugs. Cimetidine has been shown to increase the bioavailability of Reminyl. Ketoconazole, paroxetine,and erythromycin have also been shown to increase the bioavailability of Reminyl. Reminyl does not seem to interact with warfarin or digoxin. The most common side effects encountered with Reminyl seem to occur in the higher dose ranges. Nausea,vomiting,anorexia,and dizziness are the most frequent effects encountered. Fatigue ,headache,and sleepiness are other possible side effects.Reminyl is distributed in the United States by Janssen Pharmaceuticals. |