Table 5. Drugs for Treatment of Mild, Moderate and Severe Alzheimer Agent
Suggested Dosage Cholinesterase Inhibitors
Donepezil hydrochloride (Aricept®)
Oral: FDA-approved for mild, moderate and severe Alzheimer's Disease
Galantamine (Reminyl®)
Oral: FDA-approved for mild and moderate Alzheimer's Disease only
Start: 5 mg q day Escalation: 10 mg q day aſter 4-6 weeks if tolerated Aſter 3 mos may increase to 23 mg q day
Immediate Release: Start: 4 mg bid Escalation: 8 mg bid aſter 4 weeks. May increase to
16 mg bid aſter an additional 4 weeks. Max: 24 mg/day Extended Release: (Note: Razadyne ER is once daily) Start: 8 mg q day or 4 mg bid Escalation: 16 mg q day aſter 4 weeks or 8 mg bid aſter 4 weeks. May increase to 24 mg q day. (32 mg/day not more effective in Alzheimer's Disease)
Rivastigmine tartrate (Exelon®)
Oral: FDA-approved for mild and moderate Alzheimer's Disease only
Rivastigmine (Exelon® Patch)
Transdermal: FDA-approved for mild to moderate Alzheimer's Disease only
Start: 1.5 mg bid Escalation: 3 mg bid aſter 4 weeks. May increase to
4.5 mg bid aſter an additional 4 weeks. May increase to 6 mg bid aſter an additional 4 weeks.
Start: 4.6 mg/24 hour patch q day Escalation: 9.5 mg/24 hour patch q day aſter 1 month When switching from oral to the patch: For a total daily dose of less than 6 mg oral rivastigmine switch to 4.6 mg/24 hour patch (first check medication adherence). For a total daily dose between 6-12 mg of oral rivastigmine switch to 9.5 mg/24 hour patch. Apply the first patch on the day following the last oral dose.
N-Methyl-D-Aspartate [NMDA] Receptor Antagonists
Memantine (Namenda®)
Oral: FDA-approved for moderate to severe Alzheimer's Disease
Start: 5 mg q day for 1 week Escalation: 5 mg bid for 1 week, then 5 mg and 10 mg in separate doses for 1 week, then 10 mg bid Reduce dose in people with renal impairment (see "Cautions and Comments").
