Alzheimer’s Medications: Comparing Your Treatment Options
Key takeaways:
There are many ways to treat Alzheimer’s disease, which is the most common form of dementia. Lifestyle adjustments are recommended to manage symptoms when possible. But your healthcare team may also recommend that you take medication.
Cholinesterase inhibitors, such as donepezil (Aricept, Adlarity), are first-choice medications for treating symptoms of Alzheimer’s-related dementia. And anti-amyloid therapies, such as Leqembi (lecanemab), may help slow down the condition from getting worse.
There are ways to save on Alzheimer’s medications. Many options are available as lower-cost generics or have copay savings opportunities. GoodRx can help make your prescription more affordable.
Access savings on related medications
Table of contents
Finding the best treatment for Alzheimer’s disease is a story that’s still being written. Many medications for dementia caused by Alzheimer’s disease have fallen short in clinical trials, and many more are still being studied.
Although these efforts are still ongoing, many medications are already FDA approved to treat Alzheimer’s-related dementia.
If you or a loved one are showing early signs of dementia or have Alzheimer’s disease, learning about your treatment options — now or in the future — is an empowering step to consider taking.
What’s the best medication for Alzheimer’s-related dementia?
There are many ways to treat Alzheimer’s-related dementia; medications are only one option to consider. Lifestyle changes, such as regular exercise and eating a healthy diet, are often recommended first. But medications can also help in some cases.
Most of these medications target specific Alzheimer’s-related symptoms, such as changes in memory and thinking. Newer medications aim to tackle the condition at its source. But this doesn’t mean that newer therapies are considered better than the rest.
Below, we’ll review the pros and cons of four medication categories for Alzheimer’s disease.
1. Cholinesterase inhibitors
Cholinesterase inhibitors are first-choice options for treating symptoms related to thinking, judgment, and memory.
Cholinesterase inhibitors help your brain cells communicate with one another better. They accomplish this by allowing a chemical messenger called acetylcholine to stick around in the brain for longer.
Donepezil
Donepezil (Aricept) is the most commonly prescribed Alzheimer's medication. It’s a cholinesterase inhibitor that treats mild, moderate, and severe forms of Alzheimer’s-related dementia. Donepezil is typically taken as a once daily tablet, and it’s available as 5 mg, 10 mg, and 23 mg tablets. For those who have trouble swallowing pills, it also comes as a tablet that dissolves on your tongue.
Adlarity is the patch version of donepezil. But instead of swallowing the medication or letting it dissolve on your tongue, you can apply it to your skin once a week. This makes for a convenient way to get your daily dose — especially if it’s hard to take a pill every day. It’s available as a 5 mg per day and 10 mg per day patch.
Adlarity is just as effective as donepezil tablets, but it may take a bit longer to start working.
Rivastigmine
Rivastigmine (Exelon) is another cholinesterase inhibitor. And it comes in a few different dosage forms.
As a twice-daily oral capsule, rivastigmine can treat mild or moderate forms of the condition. The capsules are available in doses ranging from 1.5 mg to 6 mg.
As a once-daily patch that you apply to your skin, rivastigmine can treat mild, moderate, and severe forms of Alzheimer’s-related dementia. The patches are available in doses of 4.6 mg, 9.5 mg, and 13.3 mg.
Studies suggest that rivastigmine’s effectiveness is similar to donepezil and galantamine. Choosing between these medications often boils down to the risks and side effects of each, which we also outline later on. Your preferences and insurance status also play roles.
Galantamine
Galantamine is another cholinesterase inhibitor. It can treat mild-to-moderate forms of Alzheimer’s-related dementia. Specific doses vary by form, but it’s typically taken 1 to 2 times per day. It’s available as a liquid and as immediate-release (IR) and extended-release (ER) tablets.
2. Glutamate regulators
Memantine (Namenda) is an NMDA (N-methyl-D-aspartate) receptor antagonist, also known as a glutamate regulator. It’s thought that the NMDA receptor (chemical binding site) is overstimulated in Alzheimer’s disease. Memantine stops a chemical messenger called glutamate from overstimulating the NMDA receptor in your brain.
Memantine can treat moderate-to-severe forms of Alzheimer’s-related dementia, helping address cognitive symptoms such as memory, attention, and the ability to perform daily tasks. It comes as a liquid, an IR tablet, and an ER capsule, and it’s taken 1 to 2 times per day.
Memantine isn’t typically used by itself, though. It’s often combined with one of the cholinesterase inhibitors mentioned above. There’s even a combination medication that contains both donepezil and memantine, which is called Namzaric.
3. Anti-amyloid therapies
Aduhelm (aducanumab) and Leqembi (lecanemab) are monoclonal antibody medications used to treat mild Alzheimer’s disease. They’re different from the medications discussed above because they target the Alzheimer’s disease process itself. More specifically, they target protein clumps in the brain called beta-amyloid plaques. Lowering the amount of these harmful plaques in the brain may prevent Alzheimer’s disease from getting worse.
Both Aduhelm and Leqembi are given as intravenous (IV) infusions. Every dose takes about 1 hour to receive. Aduhelm is given every 4 weeks, whereas Leqembi is given every 2 weeks. Between the two, Leqembi has more clinical effectiveness data available.
Important: On January 31, 2024, Aduhelm’s manufacturer announced that it plans to discontinue Aduhelm in the U.S. The same company that makes Aduhelm produces Leqembi, and they plan to prioritize Leqembi’s development and commercialization instead.
4. Medications that manage specific Alzheimer’s symptoms
Dementia symptoms, such as memory loss, disorientation, and decision making difficulties, are the most common signs of Alzheimer’s disease. But you or your loved one may experience other changes in behavior, too. Other symptoms of Alzheimer’s disease can include:
Agitation
Aggression
Anxiety
Depression
Trouble sleeping (insomnia)
Restlessness
If symptoms like these become bothersome or frequent, your healthcare team may recommend that you take additional medication. Below are two FDA-approved medications used to manage Alzheimer’s symptoms. However, other off-label medications may be recommended too.
Belsomra for insomnia
Belsomra (suvorexant) is a controlled substance that treats insomnia, and it’s been studied in people with mild-to-moderate Alzheimer’s disease. Belsomra works by blocking orexin — a chemical messenger that plays a role in keeping you awake.
Belsomra is an oral tablet that’s available in tablets ranging from 5 mg to 20 mg. You shouldn’t take it more than once a night.
Rexulti for agitation
Rexulti (brexpiprazole) is an atypical antipsychotic used to treat dementia-related agitation in people with Alzheimer’s disease. It works by changing the levels of certain chemicals in your brain that affect your mood. It’s a once-daily oral tablet that is available in six doses, ranging from 0.25 mg to 4 mg.
However, Rexulti carries a boxed warning. A boxed warning is the FDA’s most serious medication warning about risks and side effects. It’s been linked to a higher risk of death in older adults with dementia-related psychosis. As a result, people who aren’t experiencing agitation shouldn’t take Rexulti.
What are the side effects of Alzheimer’s medications?
When it comes to choosing specific medications for Alzheimer’s disease, it sometimes comes down to their potential side effects. Here are some notable side effects of medications that treat Alzheimer’s-related dementia.
| Medication | Most common side effects |
|---|---|
| Donepezil tablets |
|
| Adlarity (donepezil patches) |
|
| Rivastigmine patches |
|
| Rivastigmine capsules |
|
| Galantamine |
|
| Memantine |
|
| Aduhelm |
|
| Leqembi |
|
| Belsomra |
|
| Rexulti |
|
Important: This isn’t an all-inclusive list. More serious side effects are also possible, albeit rare. If you or your loved one experience any side effects that feel worrisome, contact your healthcare provider right away.
How to save on Alzheimer’s medications
There are many ways to save on Alzheimer’s medications. GoodRx can help you navigate your options, which may include GoodRx discounts, copay savings cards, and patient assistance programs. You may be able to find Alzheimer’s medications for as low as $13 with a free GoodRx discount.
The bottom line
Many medications are FDA approved to treat Alzheimer’s-related dementia. The most common medications — donepezil (Aricept, Adlarity), rivastigmine (Exelon), and galantamine — are cholinesterase inhibitors that treat cognitive symptoms. Depending on the situation, you may also be prescribed a medication such as memantine (Namenda), which has an additive effect when paired with a cholinesterase inhibitor. You may also receive a supportive medication like Belsomra (suvorexant) for Alzheimer’s-related insomnia.
Newer anti-amyloid therapies, such as Leqembi (lecanemab), are unique because they target the disease process itself. They’re used to prevent mild Alzheimer’s from getting worse.
To see if one or more of these medications are right for you or a loved one, talk to your healthcare team.
Why trust our experts?
References
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