Health care - Treatment and medication - Medication and side effects

Cholinesterase inhibitors are medications that help preserve the ability of damaged nerve endings, so they continue to send messages from one nerve to another. These medications may be helpful for two to three years or even longer. There are three main drugs approved for people with mild to moderate symptoms:

• Aricept (also known as donepezil)
• Exelon (also known as rivastigmine)
• Reminyl (also known as extended release galantamine hydrobromide)

These medications, although meant for the same purpose, have subtle differences in their medicinal properties and therefore, one may be prescribed over the other. That is, an individual may respond to one cholinesterase inhibitor, but not another.

Some factors that may influence the type of dementia medication you are prescribed may include the type of dementia you have, how you tolerate the medication (side-effects), convenience of dosage (1x per day versus 2x per day), and if the medication is covered under the provincial drug plan, and other medical conditions that you have (e.g., underlying liver or kidney disease, asthma).

Some common side effects can include: gastrointestinal upset, mental health changes, frequent urination or incontinence, nightmares, and/or hallucinations.

Alos, some people with certain cardiac problems related to abnormal electrical function of the heart, are at increased risk of passing out; such problems should be reviewed by a doctor before the medication is prescribed.

Source: The information above comes from the following source Alzheimer Society of Canada. (2009). Alzheimer's disease: Treatment options. [Brochure]. Ontario, Canada: Alzheimer Society of Canada.

It is a medication, also known as Donepezil or E2020. It is in the group of medications called cholinesterase inhibitors. This medication is used to treat mild to moderate symptoms of dementia.

Brain cells break down, specifically cells that make acetylcholine (a chemical thought to be important for learning and memory). People with dementia have lower levels of acetylcholine. Aricept helps to stop the breakdown of the chemical, which keeps more in the brain. For some who take Aricept, it helps them to focus and think more clearly. The medication takes about 12 weeks to work and everyone's response is different to how well and how long it will continue to work.

Source: The information above comes from Alzheimer Society of Canada. (2005, May). Drugs: Aricept™. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

The most common listed side effects are nausea, diarrhea, difficulty sleeping, vomiting, muscle cramps, tiredness and loss of appetite. Some studies have reported people fainting, so if you feel unwell, or unexplained issues start to occur, see you doctor immediately.

Source: The information above comes from Alzheimer Society of Canada. (2005, May). Drugs: Aricept™. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.  

It is a medication, also known as Rivastigmine. It is in the group of medications called cholinesterase inhibitors. This medication is used to treat mild to moderate symptoms of dementia.

Brain cells break down, specifically cells that make acetylcholine (a chemical thought to be important for learning and memory), so there are lower levels of acetylcholine in people with dementia. Exelon helps to stop the breakdown of the chemical, which keeps more in the brain. For some who take Exelon, it helps them to focus and think more clearly. Exelon takes about 12 weeks to work and everyone's response is different to how well and how long it will continue to work.

Source: The information above comes from Alzheimer Society of Canada. (2007, May). Drugs: Exelon™. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

The most common listed side effects are nausea, vomiting and weight loss due to loss of appetite. In most cases, these effects are mild and go away. Diarrhea, heartburn, stomach pains, dizziness, headache, weakness, tiredness and difficulty sleeping are other reported side effects. 

Source: The information above comes from Alzheimer Society of Canada. (2007, May). Drugs: Exelon™. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

It is a medication, also known as galantamine hydrobromide. It is in the group of medications called cholinesterase inhibitors. This medication is used to treat mild to moderate symptoms of dementia.

Brain cells break down, specifically cells that make acetylcholine (a chemical thought to be important for learning and memory), so there are lower levels of acetylcholine in people with dementia. Reminyl helps to stop the breakdown of the chemical, which keeps more in the brain. For some who take Reminyl, it helps them to focus and think more clearly.

Source: The information above comes from Alzheimer Society of Canada. (2004, May). Drugs: Reminyl™. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

The most common listed side effects are nausea, vomiting, diarrhea and weight loss due to loss of appetite. Other reactions are abdominal pain, indigestion, headache, dizziness, tiredness, difficulty sleeping, and depression. 

Source: The information above comes from Alzheimer Society of Canada. (2004, May). Drugs: Reminyl™. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada. 

It is a medication, also known as memantine hydrochloride. Damage to brain cells occurs in persons diagnosed with dementia. Ebixa works to block the toxic re-absorption of glutamate leakages that damages brain cells, leaving them healthy and alive.

In studies, people with dementia taking Ebixa have helped some people to focus and think more clearly. The success of Ebixa and the length of time it works varies from person to person.

Source: The information above comes from Alzheimer Society of Canada. (2007, May). Drugs: Ebixa ®. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

Overall, this drug is well tolerated. In clinical trials, the most commonly reported side effects included agitation, falls, dizziness and diarrhea, but these occurred at the same (or lower) rate as placebo treated patients. If you have epileptic seizures, Ebixa may increase the chances of you having more seizures.

Source: The information above comes from Alzheimer Society of Canada. (2007, May). Drugs: Ebixa ®. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

New research says there may be more benefit to taking the two drugs together, but larger studies need to confirm this. Talk to your doctor and/or pharmacist about these medications and whether taking both would be beneficial to you.

Source: The information above comes from Alzheimer Society of Canada. (2007, May). Drugs: Ebixa ®. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

There are a multitude of medication related issues that you and your family and care partners need to understand as your dementia symptoms progress. The issues will change over time.

After an initial diagnosis, there are four general considerations:

1. Are you taking medications that could contribute to, or worsen memory and thinking? (e.g., anticholinergics, sedatives) [there are many examples of these, here are some common drugs:

• Diphenhydramine - commonly used in sleep and allergy medication such as Benadryl, Gravol, SleepEze, ZzzQuil, NyQuil, Aleve PM, Advil PM, Tylenol PM, Sominex, etc.)
• Chlortripolon
• Ativan
• Serax
• Valium
• Rivotril, and others
• Muscle relaxants

2. If there is a significant vascular component to your dementia, are these vascular risk factors (e.g., hypertension, heart failure, diabetes, hypercholesterolaemia) well controlled?

3. You will be offered cognitive enhancers and need appropriate education regarding treatment expectations (effectiveness and what this means in dementia) and common, but usually temporary, side effects associated with these medications

4. Persons with dementia may also have depression, anxiety, and/or insomnia, and these can and should be managed with appropriate medications

As a person's dementia progress, they start to experience the world around them differently. For this reason, it may become more difficult to control your reactions and responses. This may lead to changes in how you react physically and emotionally to your environment (i.e., mood changes, restless, anger etc.). It is often better to view these changes as 'personal expressions'.

We have created a resource to explain what we mean by personal expressions.

For some symptoms of dementia, the first step is to search for reversible causes and deal with these symptoms without use of medications if possible.

1. In the event that drug therapy is deemed necessary, it is important to keep in mind that different so called "psychotropic" drugs may be used to treat these symptoms and changes. These include antidepressants, antiepileptics and antipsychotics, all of which have multiple possible uses.
2. Treatment of these symptoms of dementia are also dynamic in that it is usually not necessary to continue these medications indefinitely

As a person moves into long-term care consider the following:

1. Is there a need to continue cognitive enhancers? Upon admission to a long-term care home, one should NOT automatically stop these medications as the person with dementia may well still be getting functional and/or behavioural benefits
2. Once the person with dementia is no longer engaged with their environment, these drugs are not likely providing benefit and could likely be discontinued with no ill effects
3. Certain other medications are likely also not necessary, and include, but are not limited to: cholesterol lowering drugs, blood pressure medications and others
4. Some medications should NOT be discontinued as they are for symptomatic relief of pain, or breathing (e.g., pain medications, medications for heart failure or chronic obstructive pulmonary disease)