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While all treatments reduced the need for full-time care, only galantamine and donepezil 10 mg reduced the overall management costs of AD patients. The somewhat greater cognitive effect provided over six months by galantamine leads to the longest estimated delay before full-time care is required and, consequently to lower overall costs, with savings estimated at between 323 dollars and 4,246 dollars.
exelon 1 5 mg bula
The cholinesterase inhibitor rivastigmine is approved for the treatment of mild to moderate Alzheimer's disease. However, it is not possible to predict which individuals will benefit from treatment. This retrospective analysis of an international, 24-week, randomized, double-blind trial aimed to identify the percentage of persons with Alzheimer's disease who have a sustained response with rivastigmine patch, rivastigmine capsules, or placebo; to determine the magnitude of the sustained treatment response; and to investigate baseline patient characteristics predictive of the observed sustained response.
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Acetylcholinesterase (AChE) predominates in the healthy brain, with butyrylcholinesterase (BuChE) considered to play a minor role in regulating brain acetylcholine (ACh) levels. However, BuChE activity progressively increases in patients with Alzheimer's disease (AD), while AChE activity remains unchanged or declines. Both enzymes therefore represent legitimate therapeutic targets for ameliorating the cholinergic deficit considered to be responsible for the declines in cognitive, behavioral and global functioning characteristic of AD. The two enzymes differ in substrate specificity, kinetics and activity in different brain regions. Experimental evidence from the use of agents with enhanced selectivity for BuChE (cymserine analogues, MF-8622) and the dual inhibitor of both AChE and BuChE, rivastigmine, indicates potential therapeutic benefits of inhibiting both AChE and BuChE in AD and related dementias. Recent evidence suggests that both AChE and BuChE may have roles in the aetiology and progression of AD beyond regulation of synaptic ACh levels. The development of specific BuChE inhibitors and further experience with the dual enzyme inhibitor rivastigmine will improve understanding of the aetiology of AD and should lead to a wider variety of potent treatment options.
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During 2000, 2001, and 2002, eligible residents began donepezil, galantamine, or rivastigmine monotherapy. Among these treatment groups, 5,846, 750, and 1,672 residents, respectively, were included in the analysis. All MDS assessments were analyzed if completed. Analyses were conducted at baseline and within one year of initiating therapy.
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Effectiveness of acetylcholinesterase inhibitors on cognitive symptoms of patients with mild to moderate Alzheimer's disease is modest. At 9 months, improvement was evident only in a subgroup of patients without concomitant diseases and who had demonstrated a response at 3 months.
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To evaluate the efficacy of a cognitive-motor program in patients with early Alzheimer disease (AD) who are treated with a cholinesterase inhibitor (ChEI).
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Rivastigmine may provide better benefits in cognitive function, but not global status, for AD patients with more advanced WMCs. The detailed mechanisms still have to be determined in future studies.
exelon 3 mg bula
Nausea and/or vomiting are frequent dose-limiting class effects of cholinesterase inhibitors, occurring mostly during the dose-escalation phase. These untoward effects make it difficult to increase rivastigmine dosage above 6 mg daily in most patients. The antiemetic domperidone was given to 22 patients with Alzheimer's disease (9 men, 13 women; mean age 74.5+/-4.6 years; mean age at diagnosis: 73.1+/-5.0 years) in 15-day prophylactic cycles, starting 15 days before each dose escalation of rivastigmine above 6 mg daily. Only four patients (18.2%) experienced nausea, which was so mild that all patients reached >or=9 mg rivastigmine daily and 16 (72.7%) reached and maintained the top dosage (12 mg daily). An improvement or stabilization of Mini Mental State Examination scores was achieved in 54.5% of the patients. The treatment regimen was well tolerated; no patients stopped treatment because of adverse events. Further investigations assessing the role of domperidone in the prevention of rivastigmine-related gastrointestinal disturbances are warranted.
The present results suggest that the risk of UI is higher in patients with AD than in the general population.
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Inappropriate sexual behaviors in dementia can be difficult to treat. Frequently, multiple psychoactive medications are used and many pharmacotherapies are trialed prior to finding an effective agent. More research is needed to clarify the usefulness of these medications and to identify non-pharmacological strategies to prevent unnecessary use of medications.