10 Drugs Commonly Prescribed for Alzheimer's Symptoms

Medically Reviewed By William C. Lloyd III, MD, FACS
Was this helpful?
81
Caucasian pharmacist giving prescription to customer
Getty

More than 6 million Americans are living with Alzheimer’s disease, making it the most common type of dementia. It gradually worsens over the course of years and causes progressive declines in memory, communication and thinking. Drugs for Alzheimer’s treatment can slow cognitive changes and improve quality of life. But drugs can’t cure Alzheimer’s disease and eventually, the disease will be fatal.

There are several types of dementia. In general, the drugs used for dementia memory problems are the same. But treatments can vary slightly. For example, some drugs for behavioral problems can aggravate an underlying condition, such as Parkinson’s disease. So, it’s important to get an accurate dementia diagnosis.

Classes of Alzheimer’s Disease Drugs

The exact cause of Alzheimer’s disease remains unclear. But doctors have an understanding of the changes that take place in the brain. The two main ones are clumps of an abnormal protein (amyloid), called plaques, and tangles of nerve fibers. Basically, these changes disrupt communication between nerve cells, which eventually die.

In general, medical therapy for Alzheimer’s disease offers the greatest benefits when prescribed in the early-to-mild stages of AD. Drug treatment has traditionally aimed to improve cell-to-cell communication by enhancing brain chemicals. And there haven’t really been any new drugs for Alzheimer’s until recently. Doctors also use drugs to help manage behavioral, non-cognitive problems related to dementia.

Here is a look at the current classes of drug to treat Alzheimer’s disease and its symptoms:

  • Cholinesterase inhibitors increase levels of the brain chemical acetylcholine—a messenger that gets depleted in Alzheimer’s disease. They do this by blocking the enzyme cholinesterase, which breaks down acetylcholine. This leaves more acetylcholine intact to enhance communication between neurons. There are several drugs in this class. Common side effects include diarrhea, nausea, appetite loss, and sleep problems.

  • Monoclonal antibodies (MABs), which are biologic drugs that target specific proteins. In this case, the MAB targets the protein amyloid beta. This protein makes up the plaques that occur in the brain. A MAB can reduce these plaques, but it is currently unclear whether this has a clinical benefit. Presently, there is one drug in this class. 

  • NMDA receptor antagonists work by blocking a nerve cell receptor that gets overactivated in Alzheimer’s disease. This receptor is essential for things like learning and memory. But when it has too much stimulation, it causes nerve cell damage and death. By blocking the receptor, these drugs stop the overactivation and help preserve nerve cells. Currently, there is one drug in this class.

  • Non-cognitive medications manage behavioral problems, such as sleep disturbances, mood disorders, disruptive behavior, aggression, and hallucinations. There are several classes within the category, including anti-anxiety drugs, antidepressants, anti-psychotics, and sleep medications.

FDA Approved Drugs for Alzheimer’s Disease

The cholinesterase inhibitors are the main first-line treatment for Alzheimer’s disease. These drugs attempt to make up for depleted levels of acetylcholine. For moderate to severe disease, doctors often add the NMDA receptor drug. Researchers are still exploring the exact role of the new MAB drug.

  1. Aducanumab (Aduhelm) is a MAB and is the first new Alzheimer’s drug since 2003. It is an infusion for early-stage disease. Serious side effects can be common with this drug, including brain swelling and brain bleeding. It is worth noting that the approval of aducanumab has come under controversy.

  2. Donepezil (Aricept) is a cholinesterase inhibitor. It comes as a tablet and an orally-disintegrating tablet. You take it at bedtime, with or without food.

  3. Galantamine (Razadyne) is also a cholinesterase inhibitor. It is available as a tablet, solution, and extended-release (ER) capsule. You take the tablet and solution twice a day with morning and evening meals. The ER capsule is for once daily dosing in the morning.

  4. Lorazepam (Ativan) is a benzodiazepine that treats anxiety, restlessness, and resistant or verbally disruptive behaviors. It comes as a tablet or liquid you take 2 to 3 times a day. Common side effects include dizziness, drowsiness and fatigue.

  5. Memantine (Namenda) is the only NMDA receptor antagonist approved for Alzheimer’s treatment. Doctors may prescribe it alone or in combination with a cholinesterase inhibitor. It is available as a tablet, liquid, and ER capsule. The tablet and liquid are dosed once or twice a day, with or without food. You take the ER capsule once a day.

  6. Memantine/donepezil (Namzaric) is a combination product that contains two drugs. Combining them into one product makes it easier for some people to take, instead of taking each separately. It is an ER product for once daily dosing in the evening.

  7. Quetiapine (Seroquel) is an antipsychotic. It treats aggression, agitation, delusions, hallucinations, hostility and uncooperativeness. It is available as a regular-release tablet and an ER tablet. You take the regular tablet up to three times a day. The ER tablet is taken once daily in the evening. Common side effects include fatigue, dizziness, indigestion, headache, and weight changes.

  8. Rivastigmine (Exelon) is another cholinesterase inhibitor. It comes as a capsule and a liquid. Both have twice daily dosing with meals. There is also a patch you apply to the skin once a day.

  9. Sertraline (Zoloft) is an antidepressant. It treats irritability and low mood. It comes as a tablet and a liquid you take once a day. Common side effects include dizziness, drowsiness, dry mouth, upset stomach, nausea, and weight changes.

  10. Suvorexant (Belsomra) is an orexin receptor antagonist that treats sleep problems. It comes as a tablet you take within 30 minutes of bedtime. You can have food in your stomach, but taking it on an empty stomach will help it work faster. Like other sleep medications you need 7 to 8 hours to remain in bed.

There are also several non-drug strategies for managing the symptoms of Alzheimer’s disease. Doctors usually recommend these non-drug treatments for behavioral problems before using medications. In most cases, it takes more than one type of treatment to effectively manage the symptoms.

Was this helpful?
81
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Sep 17
View All Alzheimer's Disease Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Aduhelm Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/761178s000lbl.pdf 
  2. Alzheimer’s Disease. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447 
  3. Alzheimer’s Disease Fact Sheet. National Institute on Aging. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet#causes 
  4. Drugs, Herbs and Supplements. MedlinePlus, National Library of Medicine, National Institutes of Health. https://medlineplus.gov/druginformation.html 
  5. Facts and Figures. Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/facts-figures 
  6. How Is Alzheimer’s Disease Treated? National Institute on Aging. https://www.nia.nih.gov/health/how-alzheimers-disease-treated 
  7. Kuns B, Rosani A, Varghese D. Memantine. [Updated 2021 Jul 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500025/ 
  8. Medications for Memory, Cognition and Dementia-Related Behaviors. Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory#Types%20of%20drugs 
  9. Top 300 of 2021. ClinCalc. https://clincalc.com/DrugStats/Top300Drugs.aspx 
  10. Treatments for Behavior. Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/treatments/treatments-for-behavior