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Key takeaways
Donepezil, a standard treatment for Alzheimer’s disease, may have undesirable effects, leading patients and caregivers to seek alternatives.
Alternatives to donepezil include cholinesterase inhibitors like Aricept, NMDA receptor antagonists like Namenda, and newer options like Aduhelm that target amyloid beta plaques.
Natural alternatives and lifestyle changes, such as nutritional education, exercise, and possibly vitamin E supplements, can also support the management of Alzheimer’s disease.
Switching from donepezil to another medication should be done under the guidance of a healthcare provider, considering potential drug interactions and the patient’s health history.
The treatment of Alzheimer’s disease is garnering more attention and capturing headlines as the prevalence of dementia in older adults climbs. One of the longest-standing treatments, donepezil, is still a common first-line prescription for a disease marked by memory loss and functional decline. The drug is an imperfect solution to a complex and frustrating condition. As a patient or one of the caregivers, you may not have a great experience with it.
Adverse effects are a significant reason people seek alternatives to donepezil, but desiring more relief from the symptoms of Alzheimer’s dementia is another motivator for those exploring other options. While the list of alternatives is still not long, it is growing and worth considering. We will delve into that list, covering the different categories and drugs and calling attention to the most common picks.
What can I take in place of donepezil?
Donepezil is better known by the brand name Aricept. As an acetylcholinesterase inhibitor, Aricept reduces the breakdown of acetylcholine (a neurotransmitter) in the synaptic space between brain cells. Boosting acetylcholine levels can offset the deficit in the brains of those with Alzheimer’s dementia. The drug category of acetylcholinesterase inhibitors (also known simply as cholinesterase inhibitors) has other members— so you could pick a different one if Aricept is not working out.
Besides cholinesterase enzyme inhibitors, Namenda, an NMDA antagonist, is also available as a therapeutic for Alzheimer’s disease. Namenda and its generic form, memantine, are NMDA receptor blockers, thereby preventing excess stimulation of the receptor by glutamate. As a result, further brain cell injury can be prevented, and a degree of cellular recovery is possible.
Aduhelm, the brand name of generic aducanumab, is a newer option with a novel mechanism of action in the battle against Alzheimer’s disease. It was just approved in 2021 by the Food and Drug Administration. Aduhelm is a monoclonal antibody that targets amyloid beta, the protein which piles up in the brain and seems to be at the root of the disease.
Compare donepezil alternatives |
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|---|---|---|---|
| Drug name | Uses | Dosage | Savings options |
| Aricept (donepezil hydrochloride) | Alzheimer’s disease | 5 to 23 mg once daily at bedtime | Aricept coupons |
| Rivastigmine tartrate | Alzheimer’s disease, Parkinson’s disease-related dementia | 1.5 to 6 mg twice daily | Rivastigmine coupons |
| Exelon patch (rivastigmine) | Alzheimer’s disease, Parkinson’s disease-related dementia | 4.6 to 13.3 mg patch changed daily | Exelon patch coupons |
| Galantamine hydrobromide | Alzheimer’s disease | 4 to 12 mg twice daily | Galantamine coupons |
| Razadyne ER (extended–release galantamine) | Alzheimer’s disease | 8 to 24 mg once daily | Razadyne ER coupons |
| Namenda (memantine) | Alzheimer’s disease | 10 mg twice daily after initial titration | Namenda coupons |
| Namenda XR (extended–release memantine) | Alzheimer’s disease | 28 mg once daily after initial titration | Namenda XR coupons |
| Namzaric (extended–release memantine with donepezil) | Alzheimer’s disease | 28 mg/10 mg once daily after initial titration | Namzaric coupons |
| Aduhelm (aducanumab) | Alzheimer’s disease | 10 mg per kg of body weight intravenous every four weeks after initial titration | Aduhelm coupons |
Top 5 donepezil alternatives
The following are some of the most common alternatives to donepezil.
1. Exelon patch
Like its fellow cholinesterase inhibitors, the common adverse effects of donepezil are nausea and diarrhea, which can be coupled with the loss of appetite and weight loss. If you are experiencing these issues and need an alternative with fewer stomach effects, Exelon patches deliver the cholinesterase inhibitor rivastigmine via a transcutaneous mechanism that avoids the gastrointestinal tract. There is still the chance of other side effects from cholinesterase blockade, such as dizziness and bradycardia (slow heart rate), and keep in mind that the patch could cause skin irritation. For those who cannot swallow a pill, the Exelon patch or the disintegrating tablet form of donepezil are excellent options.
2. Namenda XR
Side effects from cholinesterase inhibitors could send you looking for anything else. The NMDA receptor antagonist memantine works via a different mechanism and is generally well tolerated. The convenience of once-daily dosing is present with Namenda XR (extended-release memantine) like it is with Aricept, and both have the cost advantage of having a generic form available.
Memantine’s FDA-approved indication specifies moderate to severe Alzheimer’s disease, compared to Aricept’s indication for mild, moderate, and severe stages of the disease. In reality, both categories of medication have only modest benefits for cognitive function. Memantine is often added to a cholinesterase inhibitor when Alzheimer’s disease worsens. Greater efficacy is needed beyond the early stages of Alzheimer’s. Namenda XR could replace Aricept if side effects are an issue or an add-on to Aricept if more effectiveness is desired.
3. Namzaric
Since donepezil and memantine are frequently used in tandem, it might make sense to reduce the number of pills needed per day by taking Namzaric, a combination product with both donepezil and extended-release memantine. The greater convenience comes at a higher price based on Namzaric being a brand-name-only drug. If the cost seems prohibitive, try presenting a SingleCare discount card for assistance at your local pharmacy.
RELATED: How much is Namzaric without insurance?
4. Razadyne ER
If you are tolerating Aricept but wish to try an alternative oral cholinesterase inhibitor, Razadyne ER could be of interest. The drug provides galantamine in a once-daily pill. Generic extended-release galantamine is also available.
5. Aduhelm
Treatment of Alzheimer’s disease had not seen a new drug option for over a decade until the FDA approved Aduhelm for use in patients with mild forms of the condition. It is a monthly intravenous infusion that reduces amyloid beta plaques in the brain. Use remains controversial because a benefit for patient symptoms is still unproven by clinical studies. Aduhelm carries a hefty price tag, and it is not appropriate for any other form of dementia, such as dementia with Lewy bodies and vascular dementia.
Natural alternatives to donepezil
When considering alternatives to donepezil, you should not overlook the impact of nutritional education and exercise programs in the setting of dementia. They can help improve quality of life. Likewise, you may be interested in supplements as a treatment option for Alzheimer’s. Evidence to support any particular supplement is lacking in general, but vitamin E does have a small amount of proof for slowing functional decline but not cognitive decline. Besides the treatment of Alzheimer’s disease, prevention is also of interest. Of the diets and supplements tried to date, a Mediterranean-style diet has generated the most enthusiasm, although clinical trials are still limited.
How to switch to a donepezil alternative
Making a lifestyle change, trying a supplement, and adjusting a medical regimen are all topics that need to be brought up to your healthcare provider when considering a medication change. Make an appointment with a prescribing healthcare professional to discuss the details of your concerns regarding donepezil and what alternatives you are interested in. After listening to your thoughts, reviewing your list of over-the-counter and prescription medications for drug interactions, and reviewing your health history, the provider can propose a plan.