Donepezil vs. Rivastigmine for Alzheimer's Disease: Important Differences and Potential Risks.

Donepezil

(Aricept)

Rivastigmine

Summary for Donepezil

Prescription only

Donepezil (Aricept) is a medication that's used to help adults with symptoms of dementia related to Alzheimer's disease (AD). It belongs to the drug class called cholinesterase inhibitors. Donepezil (Aricept) is taken once a day. It comes as both a brand-name and generic tablet that you swallow. There's also a generic orally disintegrating tablet (ODT) that melts on the tongue. Possible side effects include nausea, diarrhea, and trouble sleeping.

Indications for Donepezil

Dementia related to Alzheimer's disease (AD)

Pros and Cons for Donepezil

Pros

First-choice treatment option for Alzheimer's disease
Can help with all stages of Alzheimer's disease (mild, moderate, or severe)
Taken once a day with or without food
Dissolvable pills available for some people who have trouble swallowing pills (5 mg and 10 mg only)

Cons

Not a cure for Alzheimer's
Often causes nausea and diarrhea
Can have interactions with anticholinergic medications like oxybutynin and scopolamine (Transderm Scop)
Might not be a good option for people with a history of stomach ulcers or breathing problems

Common Side Effects for Donepezil

Nausea (11%)
Diarrhea (10%)
Headache (10%)
Trouble sleeping (insomnia, 9%)
Pain (9%)
Dizziness (8%)
Muscle cramps (6%)
Tiredness (5%)
Vomiting (5%)
Loss of appetite (4%)

Warnings for Donepezil

Slower heartbeat
Nausea and vomiting
Stomach ulcers and bleeds
Weight loss
Caution use in people with urinary problems
Caution use in people with breathing problems

Summary for Rivastigmine

Prescription only

Rivastigmine is used to help adults with symptoms of dementia related to Alzheimer's disease or Parkinson's disease. It belongs to the drug class called acetylcholinesterase inhibitors. Rivastigmine capsules are taken by mouth twice per day. The dosage typically depends how well you can tolerate the medication. Common side effects include nausea, vomiting, and diarrhea. The brand-name version of the capsule, Exelon, is no longer available. But you can still get the capsules as a generic.

Indications for Rivastigmine

Dementia related to Alzheimer's disease or Parkinson's disease

Pros and Cons for Rivastigmine

Pros

A treatment option for dementia related to Alzheimer's or Parkinson's
A pill that's taken by mouth
Available in several strengths

Cons

Taken twice per day with food
Not available in a liquid form
Can worsen the symptoms of other medical conditions (e.g., breathing problems, trouble urinating, stomach ulcers)