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Do you want a document about Alzheimer disease, help finding an Alzheimer specialist, or something else?
Drug of choice
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Alzheimer disease treatment cholinesterase inhibitors memantine FDA patient guidance
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Alzheimer disease treatment
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https://nia.nih.gov/health/how-alzheimers-disease-treated
Drug of choice for symptomatic Alzheimer disease: Donepezil is commonly used first line.
- It is a cholinesterase inhibitor and can be used in mild, moderate, and severe Alzheimer disease.
- Alternatives for mild to moderate disease: rivastigmine or galantamine.
- For moderate to severe disease: add or use memantine. Donepezil plus memantine may be used together.
These drugs improve symptoms modestly but do not cure Alzheimer disease. Prescription choice depends on heart rate/conduction disease, stomach-ulcer or bleeding risk, weight loss, and adverse effects such as nausea, diarrhea, and bradycardia. NIA treatment guidance and Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, p. 13056 support this staging approach.
For early biomarker-confirmed Alzheimer disease, disease-modifying anti-amyloid medicines such as lecanemab or donanemab may be considered only through specialist assessment and MRI monitoring.
Drug of choice for alzeimer
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site:nia.nih.gov Alzheimer disease donepezil mild moderate severe memantine treatment
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Alzheimer disease treatment
Quick answer
Donepezil is the usual first-line drug for symptomatic Alzheimer disease.
- Mild to moderate: donepezil, rivastigmine, or galantamine
- Moderate to severe: memantine, often combined with donepezil
Donepezil is commonly preferred because it can be used across mild, moderate, and severe stages.
Tellme fast
Donepezil.
For moderate to severe Alzheimer disease: memantine, often with donepezil.
For moderate to severe Alzheimer disease: memantine, often with donepezil.
Why not rivastigmine?
Rivastigmine is also a valid option. It is not wrong.
Donepezil is often preferred first because it is once daily and approved for mild, moderate, and severe Alzheimer disease.
Use rivastigmine when:
- donepezil is not tolerated
- a skin patch is preferable, such as swallowing difficulty or poor adherence
- the patient also has Parkinson disease dementia
Rivastigmine, especially oral form, can cause more nausea, vomiting, poor appetite, and weight loss.
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