Alzheimer Dementia Treatments

ALZHEIMER DEMENTIA TREATMENTS
Generic	Brand	Strength	Form	Adult Dose
AMYLOID BETA-DIRECTED ANTIBODY
aducanumab-avwa	Aduhelm	100mg/mL	soln for IV infusion after dilution	Mild cognitive impairment/mild dementia: Infuse over 1hr every 4wks. Infusions 1 and 2: 1mg/kg. Infusions 3 and 4: 3mg/kg. Infusions 5 and 6: 6mg/kg. Infusion 7 and beyond: 10mg/kg.
lecanemab-irmb	Leqembi	100mg/mL	soln for IV infusion after dilution	Mild cognitive impairment/mild dementia: 10mg/kg infused over ~1hr, once every 2wks. Patients with amyloid related imaging abnormalities -edema (ARIA-E) and -hemosiderin deposition (ARIA-H): see full labeling.
CHOLINESTERASE INHIBITORS
donepezil	—	5mg, 10mg	ODT	Mild-moderate: Initially 5mg daily at bedtime, may increase to max 10mg daily after 4−6wks; usual dose: 5mg or 10mg once daily. Moderate-severe: Initially 5mg daily at bedtime, may increase to 10mg daily after 4−6wks; may further increase to max 23mg daily after 3mos; usual dose: 10mg or 23mg once daily.
	Aricept	5mg, 10mg, 23mg	tabs
	Adlarity	5mg/day, 10mg/day	patch	Initially 5mg/day once weekly; may increase to max 10mg/day after 4–6wks. Replace patch after 7 days. Rotate application site every 2wks.
galantamine	—	4mg/mL	soln	Mild‑moderate: Give with AM & PM meals. Initially 4mg twice daily; if well-tolerated, increase to maintenance dose 8mg twice daily (16mg/day) after minimum of 4wks; may attempt further increase to 12mg twice daily (24mg/day) after minimum of 4wks. Re‑titrate if interrupted for >3 days. Moderate hepatic or renal impairment (CrCl 9−59mL/min): usual max 16mg/day. Avoid in severe hepatic or renal impairment.
	—	4mg, 8mg, 12mg	tabs
	Razadyne ER	8mg, 16mg, 24mg	ext-rel caps	Mild‑moderate: Give with AM meal. Initially 8mg/day; if well-tolerated, increase to maintenance dose 16mg/day after minimum of 4wks; may attempt further increase to max 24mg/day after minimum of 4wks. Re‑titrate if interrupted for >3 days. Moderate hepatic or renal impairment (CrCl 9−59mL/min): usual max 16mg/day. Avoid in severe hepatic or renal impairment. Switching from IR tabs to ER caps: give the same total daily dose.
rivastigmine	—	1.5mg, 3mg, 4.5mg, 6mg	caps	Mild‑moderate: Take with food in the AM and PM. Initially 1.5mg twice daily; if well-tolerated, may increase by 1.5mg twice daily at intervals of at least 2wks. Usual range: 6−12mg/day; max 12mg/day. If dose is not tolerated, suspend for several doses and restart at same or next lower dose. If stopped for >3 days, restart at 1.5mg twice daily and retitrate. Moderate to severe renal or mild to moderate hepatic impairment: use lower doses. Low body wt. (<50kg): monitor for toxicities and consider reducing dose.
rivastigmine	Exelon	4.6mg/ 24hrs, 9.5mg/ 24hrs, 13.3mg/ 24hrs	patch	Initially apply one 4.6mg/24hrs patch once daily; if tolerated, may increase to 9.5mg/24hrs patch after 4wks at previous dose; can further be increased to max 13.3mg/24hrs dose. Mild-moderate: usually 9.5mg/24hrs or 13.3mg/24hrs once daily. Severe: usually 13.3mg/24hrs once daily. If dosing interrupted for ≤3 days, restart with the same or lower dose. Mild-to-moderate hepatic impairment: initial and max dose 4.6mg/24hrs patch. Low body wt. (<50kg): monitor for toxicities and consider reducing maintenance dose to 4.6mg/24hr patch.
N-METHYL-D-ASPARTATE RECEPTOR ANTAGONIST
memantine	—	2mg/mL	soln	Moderate‑severe: Initially 5mg once daily; titrate at intervals of at least 1wk to 5mg twice daily, then to 5mg and 10mg as separate doses, then to 10mg twice daily (prescribe Titration Pak for 1st 4wks). Severe renal impairment (CrCl 5−29mL/min): titrate to max 5mg twice daily.
	Namenda	5mg, 10mg	tabs
	Namenda XR	7mg, 14mg, 21mg, 28mg	ext-rel caps	Moderate‑severe: Initially 7mg once daily; titrate at intervals of at least 1wk in increments of 7mg to target dose of 28mg once daily. Max 28mg once daily. Severe renal impairment (CrCl 5−29mL/min): titrate to target dose of 14mg/day. Switching from IR tabs: give XR caps the day after last dose of IR tabs; see full labeling.
NMDA RECEPTOR ANTAGONIST + ACETYLCHOLINESTERASE INHIBITOR
memantine extended- release/ donepezil	Namzaric	7mg/ 10mg, 14mg/ 10mg, 21mg/ 10mg, 28mg/ 10mg	caps	Moderate‑to-severe: Start the day after last dose of memantine and donepezil given separately. Patients stabilized on donepezil 10mg: initially 7mg/10mg once daily in the PM; increase in 7mg increments of memantine at intervals of ≥1wk to max 28mg/10mg once daily; severe renal impairment (CrCl 5–29mL/min): initially 7mg/10mg once daily in the PM; increase to 14mg/10mg once daily after one week. Patients stabilized on both components: 28mg/10mg once daily in the PM; severe renal impairment (CrCl 5–29mL/min): 14mg/10mg once daily.
NOTES
Key: ER, XR = extended-release; IR = immediate-release; ODT = orally-disintegrating tablets Not an inclusive list of medications, indications, or doses. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 6/2023)

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