Page 177 - The Memory Program How to Prevent Memory Loss and Enhance Memory Power

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Donepezil (Aricept): The Prescription Choice for Mild Memory Loss

The success of donepezil in treating not only Alzheimer's disease but also some people with mild
memory loss (like Diane Pozniak, described at the beginning of this chapter) has led the National
Institute of Aging to launch a large-scale controlled study with both donepezil and vitamin E to find
out how effective these medications are for people with mild to moderate memory loss. The results
of that study are likely to have a major impact on the use of these two agents to treat mild memory
loss, and as a preventive strategy for age-related memory loss.

Donepezil ranks at the top of my list of potentially useful prescription medications to prevent age-
related memory loss, and to treat mild memory loss. Donepezil's cholinesterase inhibiting activity is
similar to tacrine, but it has one great advantage: low toxicity. It has the added benefit of once-a-day
dosing (5 or 10 mg). The main side effect is nausea or diarrhea, which affects a small number of
people taking this medication. If your stomach can tolerate Aricept 5 mg daily, raising it to 10 mg
daily should not present any problems. As with many new medications, Aricept is expensive ($3 to
$6 daily).

Rivastigmine (Exelon)

Rivastigmine (Exelon) received FDA approval to treat Alzheimer's disease in May 2000, and it is a
cholinesterase inhibitor that is very similar to donepezil (Aricept) in its clinical effects. Rivastigmine
is given in doses of 3 to 12 mg daily but has to be taken twice (morning and evening), unlike the
once-a-day dose for donepezil. Rivastigmine's common side effects include stomach upset, headache,
and fatigue. More research is needed to find out if Exelon possesses any significant advantages over
Aricept, but current information suggests few differences.

Other Cholinergic Compounds for Clinical Use

Currently, several pharmaceutical companies are trying to develop other cholinergic compounds to
treat Alzheimer's disease (and mild memory loss), some of which are likely to be approved by the
FDA during 2000–2001. Galantamine (Reminyl), which was provisionally approved by the FDA in
late 2000, is very similar to donepezil (Aricept) and rivastigmine (Exelon) in its clinical effects.
Galantamine is recommended in doses of 16 to 24 mg per day.