If someone in your family, perhaps your beloved mother, father, grandmother or aunt, is suffering from Alzheimer's disease, we know how challenging it can be. Words cannot describe the sadness and helplessness you feel as you gradually lose your memory and find it difficult to carry out daily tasks. Although there is still no cure for Alzheimer's disease, there are medications that can help control the symptoms and make life a little easier. So, today we are talking about a special class of medications that doctors often recommend for this.
Let's simply understand how this medicine works, shall we?
To understand this, let's first take a look at how our brains work. The nerve cells in our brains, called neurons, talk to each other and exchange information through chemical messengers, much like a postman delivering letters.
One such important messenger is acetylcholine . It helps with many important things like our memory, learning, and attention.
However, when Alzheimer's disease develops, the nerve cells that produce these messengers called acetylcholine are gradually destroyed. Then the number of these messengers in the brain decreases. The remaining ones naturally break down when they are done with their work.
This is where drugs called Cholinesterase Inhibitors come in. These drugs work by slowing down the breakdown of the remaining acetylcholine messengers. This means they are preserved and allowed to work in the brain for as long as possible. This results in a temporary improvement in memory and thinking skills.
Simply put, these medications do not cure the disease. Instead, they control the symptoms and provide temporary relief to the patient.
Commonly used Cholinesterase Inhibitor medications
There are several Cholinesterase Inhibitor medications approved for the treatment of Alzheimer's disease worldwide and in Sri Lanka. Your doctor will select the most appropriate medication based on the nature of the disease and the patient's condition.
| Name of the medicine (brand name) | Use cases | Common side effects |
|---|---|---|
| Donepezil (Aricept) | For mild, moderate, and severe cases of the disease. Taken as one tablet once a day. | Nausea, vomiting, flatulence, muscle cramps, fatigue, loss of appetite. |
| Rivastigmine (Exelon) | For mild to moderate cases (tablets). Also available as a skin patch for severe cases. | Nausea, vomiting, flatulence, loss of appetite, and stomach pain (these are less common when using the patch). |
| Galantamine (Razadyne) | For mild to moderate cases of the disease, take twice a day or as a long-acting capsule once a day. | Nausea, vomiting, flatulence, loss of appetite, headache , dizziness. |
| Donepezil + Memantine (Namzaric) | It is produced in combination with another drug (NMDA agonist) for moderate to severe cases of the disease. | Headache , confusion, dizziness, constipation, nausea, vomiting. |
What if I have side effects when I start taking the medication?
Some people may experience side effects when they first start taking this medication. But don't worry. Most of the time, these side effects will go away as your body gets used to the medication. Your doctor will usually start you on a very low dose and gradually increase the dose.
If you have nausea, taking the medicine with food can help control it. The most important thing is to talk to your doctor about any discomfort you are experiencing. He or she will be able to provide you with the best solution.
How effective is this medicine really?
This is a problem for many people. To be honest, the results of these medications are temporary. Some patients can see a significant reduction in symptoms. They are able to think a little more clearly, remember things, and perform daily tasks more easily. This condition can sometimes last for several years.
But we must understand that this is like temporarily putting a plaster over a leaky tank. It will stop the water from leaking for a while, but the patch will become useless as the hole in the tank gets bigger. Similarly, these drugs cannot stop or reverse the damage to the brain caused by Alzheimer's disease. Over time, as the disease progresses, and the brain's production of acetylcholine almost completely stops, these drugs also have no effect.
Are there people who should not take this medication?
Yes. This medication is not suitable for everyone. Cholinesterase inhibitors can lower heart rate and blood pressure. Therefore, doctors are very careful when giving them to people with certain health conditions.
- People with asthma
- People with heart rhythm abnormalities
- People with kidney or liver disease
- People with stomach ulcers
If your loved one has any of these conditions, be sure to inform your doctor about it.
Very important: Tell your doctor about any medications , vitamins, nutritional supplements, and even Ayurvedic or Sinhala medicines your loved one is taking. Some medications (e.g., some cold and allergy medications) can interact with these Cholinesterase Inhibitors, making both medications less effective or causing dangerous side effects.
Take-Home Message
- Cholinesterase inhibitors are not a cure for Alzheimer's disease. They only temporarily control symptoms related to memory and thinking.
- This medication works by increasing the levels of a chemical messenger called acetylcholine in the brain.
- Side effects such as nausea and vomiting may occur at the beginning of the medication, but they often decrease over time.
- Never stop taking medication or change the dosage without your doctor's advice.
- It is imperative to inform your doctor about all other medications your loved one is taking.
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