PHRM 211 Lecture 27: NEUR Therapeutics of Dementia (Part 3)
Document Summary
Recall moa related to cholinergic hypothesis : block w/ cholinesterase inhibitors, ach. 3 agents seem to be equal in efficacy. Initial choice is usually based on which is most cost-effective. Few trials addressing clinical meaningfulness in improvement of assessment tool scores . Most studies only 3-6 months in duration. Monotherapy is good enough for patients with mild-to-moderate alzheimer"s disease: a. Bottom line: cholinesterase inhibitor monotherapy may improve cognitive and functional benefits compared to placebo or memantine monotherapy for mild-to-moderate ad , but neither appear to moderate-to-severe ad . Bottom line: cholinesterase inhibitors may reduce neuropsychiatric symptoms in patients with alzheimer dementia. < 10%: vomiting, anorexia, sleep disturbance, urinary frequency. Toxicity may be increased by cyp2d6 or cyp3a4 inhibitors (e. g. paroxetine, prednisone, grapefruit juice) Effectiveness may be reduced by cyp2d6 or cyp3a4 inducers (e. g. carbamazepine, phenytoin, rifampin) Target : 6-12 mg/day po in 2-3 divided doses. Adjust dose by 1. 5 mg bid q4 wk ; take with breakfast and dinner.
