Which medications in the drug class Cholinesterase Inhibitors are used in the treatment of Lewy Body Dementia?

Updated: Aug 08, 2019
  • Author: Howard A Crystal, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

Cholinesterase Inhibitors

ACh concentrations are decreased in the brains of patients with DLB. Patients with DLB are more likely than patients with Alzheimer disease to improve with cholinesterase inhibitor therapy. Fluctuations in cognition may decrease, alertness may increase, and memory may improve.

Donepezil (Aricept)

Donepezil noncompetitively inhibits centrally active acetylcholinesterase, which may increase concentrations of ACh available for synaptic transmission in the central nervous system (CNS).

Rivastigmine (Exelon)

This agent is a competitive and reversible inhibitor of acetylcholinesterase. Although the drug's mechanism of action is unknown, it may reversibly inhibit cholinesterase, which may, in turn, increase concentrations of ACh available for synaptic transmission in the CNS and enhance cholinergic function. Rivastigmine's effect may lessen as the disease process advances and fewer cholinergic neurons remain functionally intact. No evidence indicates that acetylcholinesterase inhibitors alter the course of underlying dementia.

Galantamine (Razadyne, previously called Reminyl)

Galantamine is a competitive and reversible inhibitor of acetylcholinesterase. Although its mechanism of action unknown, the drug may reversibly inhibit cholinesterase, which may, in turn, increase concentrations of ACh available for synaptic transmission in the CNS and enhance cholinergic function. Galantamine's effect may lessen as the disease process advances and fewer cholinergic neurons remain functionally intact. No evidence indicates that acetylcholinesterase inhibitors alter the course of underlying dementia. Galantamine is available in extended-release (ER) daily dosing and in immediate-release (IR) form.

Rivastigmine (Exelon patch)

Rivastigmine is a competitive and reversible acetylcholinesterase inhibitor. Although its mechanism of action is unknown, it may reversibly inhibit cholinesterase, which may, in turn, increase concentrations of ACh available for synaptic transmission in the CNS and thereby enhance cholinergic function. Rivastigmine's effect may lessen as the disease process advances and fewer cholinergic neurons remain functionally intact.

Rivastigmine is available as a 5cm2 patch containing 9 mg (releases 4.6 mg/24 h) and a 10-cm2 patch containing 18 mg (releases 9.5 mg/24 h). The drug is indicated for dementia of Alzheimer disease and for dementia associated with Parkinson disease.


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