Drug treatments for Alzheimer’s disease
5
Are there any side effects?
Generally, cholinesterase inhibitors and memantine can be taken without
too many side effects. Not everyone experiences the same side effects, or
has them for the same length of time (if they have them at all).
The most frequent side effects of donepezil, rivastigmine and galantamine
are loss of appetite, nausea, vomiting and diarrhoea. Other side effects
include muscle cramps, headaches, dizziness, fatigue and insomnia. Side
effects can be less likely for people who start treatment by taking the
lower prescribed dose for at least a month (see ‘Taking the drugs’).
The side effects of memantine are less common and less severe than for
the cholinesterase inhibitors. They include dizziness, headaches, tiredness,
raised blood pressure and constipation.
It is important to discuss any side effects with the doctor and/or the
pharmacist.
None of these drugs are addictive.
How are these drugs prescribed?
NICE guidance (2011) states that, in the rst instance, these drugs can
only be prescribed by a specialist in dementia care. This will often be
a consultant old-age psychiatrist, geriatrician or neurologist. A GP will
generally refer a person with suspected dementia to a memory service for
a specialist assessment. A consultant-led team at the clinic will carry out
a series of tests to determine whether the person has dementia and, if so,
which type. For more about the diagnosis of dementia see factsheet 426,
Assessment and diagnosis.
If the diagnosis is Alzheimer’s disease, the consultant will offer the
drugs and write the rst prescription. (In some parts of the country
arrangements allow for the consultant to write to the GP to ask them
to start prescribing.) Once the person has started on the drugs and is
stable at the optimum dose (see ‘Taking the drugs’), the specialist will