Section 05
Alzheimer's & Dementia
Cognitive & Anti-Amyloid Therapies
10 AGENTS
Donepezil
AriceptAChE inhibitor
- Forms
- Tab: 5, 10, 23mg | ODT: 5, 10mg
- Dose
- Start 5mg qHS, may increase to 10mg after 4-6wk
- MOA
- Inhibits acetylcholinesterase
Rivastigmine
Exelon patch / capsAChE/BuChE inhibitor
- Forms
- Patch: 4.6, 9.5, 13.3mg/24h | Cap: 1.5-6mg
- Dose
- Start 4.6mg/24h patch, titrate monthly to 9.5-13.3mg/24h
- MOA
- Inhibits acetyl- and butyrylcholinesterase
Galantamine
Razadyne ERAChE inhibitor + nicotinic modulator
- Forms
- ER cap: 8, 16, 24mg
- Dose
- Start 8mg/day, titrate q4wk to 16-24mg/day
- MOA
- Inhibits AChE, allosteric nicotinic modulation
Memantine
Namenda XRNMDA antagonist
- Forms
- IR: 5, 10mg | XR: 7, 14, 21, 28mg
- Dose
- Titrate weekly by 5mg to 28mg once daily (XR)
- MOA
- Noncompetitive NMDA receptor blockade
Memantine-donepezil
NamzaricNMDA antagonist + AChE inhibitor
- Forms
- Cap: 28mg/10mg, 14mg/10mg
- Dose
- 28mg/10mg once daily
- MOA
- Combined NMDA blockade + AChE inhibition
Lecanemab
LeqembiAnti-amyloid mAb
- Forms
- IV: 500mg/5mL, 200mg/2mL
- Dose
- 10mg/kg IV every 2 weeks
- MOA
- Binds amyloid-beta protofibrils
Donanemab
KisunlaAnti-amyloid mAb
- Forms
- IV: 350mg/20mL vial
- Dose
- 700mg IV x3 doses, then 1400mg IV every 4 weeks
- MOA
- Binds aggregated amyloid plaque
Brexpiprazole
RexultiAtypical antipsychotic
- Forms
- Tab: 0.5, 1, 2, 3mg
- Dose
- Start 0.5mg/day, titrate weekly to 2-3mg/day
- MOA
- Partial D2/5-HT1A agonist, 5-HT2A antagonist
Suvorexant
BelsomraOrexin receptor antagonist
- Forms
- Tab: 5, 10, 15, 20mg
- Dose
- 10-20mg qHS (insomnia in dementia)
- MOA
- Blocks orexin-mediated wakefulness
Lecanemab SC
Leqembi IqlikAnti-amyloid mAb · SC
- Forms
- SC autoinjector: 360mg/1.8mL
- Dose
- Maintenance after 18 months of IV therapy: 360mg SC once weekly
- MOA
- Binds amyloid-beta protofibrils