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183. Cognitive Impairment - Part 2: Diagnosis To Management

, delirium, seizures. See cholinesterase inhibitors above. Rivastigmine: None reported; not metabolized by cytochrome P450 system. Rivastignmine - transdermal patch Exelon Patch (not covered by provincial drug benefit plan for seniors). Initial: Apply 1 Exelon 5 transdermal patch daily; if well tolerated, increase to Exelon 10 patch after at least 4 weeks. If switching from oral rivastigmine, use Exelon 5 for patients taking <3 mg BID and Exelon 10 for patients taking See rivastigmine oral above. See (...) rivastigmine oral above. Cognitive Impairment – Part 2: Diagnosis to Treatment | February 2017 Clinical Practice Guideline Page 11 of 14 Background Comparison of the Cholinesterase Inhibitors 18 Class Drug Dose Adverse Effects Drug Interactions 3-6 mg BID. Remember to remove patch from previous day before applying new patch. Table 4: Other Drugs. Adapted with permission from Compendium of Therapeutic Choices 7 th Edition, p65- 66. 18 Other Drugs 18 Class Drug Dose Adverse Effects Drug Interactions N-methyl

2017 Toward Optimized Practice

184. Drugs to avoid

laxatives Moxifloxacin Bacterial infections Serious toxicity such as liver and cardiac disorders Ciprofloxacin, Ofloxacin Donepezil (Aricept), Galantamine (Reminyl), Rivastigmine (Exelon), Memantine Alzheimer’s and other dementias Minimal efficacy; disproportionate adverse effects such as severe vomiting and syncope Support from caregivers and family Alemtuzumab (Lemtrada), Natalizumab (Tysabri), Teriflunomide (Aubagio) Multiple sclerosis Disproportionate adverse effects such as infections and liver

2018 Therapeutics Letter

185. Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine

that is characterised by a progressive loss in cognition, function and behaviour [1]. Worldwide, the number of people living with dementia is increasing every year [2]. There are currently two classes of medications available to treat the symptoms of dementia: cholinesterase inhibitors (ChEIs: donepezil, rivastigmine and galantamine) and the N- methyl-D-aspartate (NMDA) receptor antagonist, memantine [3]. These medications are not disease modifying, yet they can have important benefits to people with dementia (...) and harm to the individual. Thus, the purpose of this guideline is to assist healthcare professionals (particularly prescribers) to determine when it might be suitable to trial withdrawal of these medications for an individual. These recommendations only apply to individuals already taking one of the described medications (donepezil, rivastigmine, galantamine and/or memantine). The main points of this guideline are as follows: ? A proportion of people who have used these medications for over 12 months

2018 Clinical Practice Guidelines Portal

186. Pharmacological treatment for memory disorder in multiple sclerosis

, secondary‐progressive and primary‐progressive MS, evaluating the absolute efficacy of donepezil, ginkgo biloba, memantine and rivastigmine versus placebo in improving memory performance with diverse assessment scales. Overall, clinical and methodological heterogeneities existed across these studies. Moreover, most of them had methodological limitations on non‐specific selections of targeted sample, non‐matched variables at baseline or incomplete outcome data (high attrition bias). Only the two studies (...) inconclusive. However, there is moderate‐quality evidence that donepezil 10 mg daily was not effective in improving memory in MS patients with mild memory impairment, but had a good tolerability. Adverse events such as nausea, diarrhoea and abnormal dreams were not frequent but were associated with treatment. Ginkgo biloba, memantine and rivastigmine were safe and well tolerated and no serious adverse effects were reported. Future large‐scale RCTs with higher methodological quality are needed. Plain

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2018 European Academy of Neurology

187. Cochrane team criticises the ECDC experts' draft advice on oseltamivir use

efficacy and safety have not been established. Translated from Med Check-TIP (in Japanese) Mar. 06 ; 6 (63):3-7Page 4· MED CHECK - TIP April 2016/ Vol.2 No.4 New Products New Products (Reminyl) and rivastigmine (Rivastouch, Exelon Patch); and an NMDA receptor antagonist (NMDA antagonist), memantine (Memary) (Table). Cholinesterase inhibitors are expected to activate mental activities by increasing acetylcholine in the brain. Memantine is expected to exhibit the similar effect by inhibiting NMDA

2016 Med Check - The Informed Prescriber

188. Parkinson's disease in adults.

of dementia with Lewy bodies. 6 At the time of publication (July 2017), rivastigmine capsules are the only treatment with a UK marketing authorisation for this indication. Donepezil, galantamine and rivastigmine patches did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's for further information. 7

2017 National Guideline Clearinghouse (partial archive)

189. Clinical practice guidelines for dementia in Australia

that the person with dementia (or their carer[s] or family) make an appointment to see a dentist to conduct an assessment and formulate a long-term treatment plan. Acetylcholinesterase inhibitors and memantine are routinely prescribed for people with mild to moderate Alzheimer disease in order to delay functional decline, and the guidelines support their use. Based on recent evidence, the guidelines also state that any one of the three acetylcholinesterase inhibitors (donepezil, galantamine or rivastigmine (...) Education Services, Department of Health and Ageing Pharmaceutical Policy Branch, Ahmed R. Post market review: Pharmaceutical Benefits Scheme anti-dementia medicines to treat Alzheimer disease. Canberra: Department of Health, 2012. (accessed Jan 2016). Birks J, Craig D. Galantamine for vascular cognitive impairment. Cochrane Database Syst Rev 2006; (1): CD004746. Birks J, McGuinness B, Craig D. Rivastigmine for vascular cognitive impairment. Cochrane Database Syst Rev 2013; (5): CD004744. Malouf R

2016 MJA Clinical Guidelines

191. Stopping Donepezil may be linked to nursing home placement for people with Alzheimer’s disease, but a “cause and effect” not conclusive

the four year study period. The participants in each group had similar characteristics and stage of disease at the beginning of the trial, but we don’t know what medication they took in the last three years of the study. The authors considered that the overall trial design was representative of usual care. What does current guidance say on this issue? NICE 2011 guidance recommends donepezil (or one of the related acetyl cholinesterase inhibitors, galantamine or rivastigmine) as a medical option (...) characteristics and stage of disease at the beginning of the trial, but we don’t know what medication they took in the last three years of the study. The authors considered that the overall trial design was representative of usual care. What does current guidance say on this issue? NICE 2011 guidance recommends donepezil (or one of the related acetyl cholinesterase inhibitors, galantamine or rivastigmine) as a medical option to treat cognitive symptoms of mild to moderate Alzheimer’s disease, provided

2018 NIHR Dissemination Centre

192. Clinical practice guidelines and principles of care for people with dementia

AND MEMANTINE 69 EBR Low Any one of the three acetylcholinesterase inhibitors (donepezil, galantamine or rivastigmine) are recommended as options for managing the symptoms of mild to moderately severe Alzheimer's disease. Any one of the three acetylcholinesterase inhibitors could be considered for managing the symptoms of severe Alzheimer’s disease. 2 Prior to initiation of treatment medical practitioners should consider performing an electrocardiogram (ECG), recording weight and undertaking a falls risk

2016 Clinical Practice Guidelines Portal

194. Stopping Donepezil may be linked to nursing home placement for people with Alzheimer’s disease, but a “cause and effect” not conclusive

the four year study period. The participants in each group had similar characteristics and stage of disease at the beginning of the trial, but we don’t know what medication they took in the last three years of the study. The authors considered that the overall trial design was representative of usual care. What does current guidance say on this issue? NICE 2011 guidance recommends donepezil (or one of the related acetyl cholinesterase inhibitors, galantamine or rivastigmine) as a medical option (...) characteristics and stage of disease at the beginning of the trial, but we don’t know what medication they took in the last three years of the study. The authors considered that the overall trial design was representative of usual care. What does current guidance say on this issue? NICE 2011 guidance recommends donepezil (or one of the related acetyl cholinesterase inhibitors, galantamine or rivastigmine) as a medical option to treat cognitive symptoms of mild to moderate Alzheimer’s disease, provided

2018 NIHR Dissemination Centre

198. Dementia

(NICE) guidelines Dementia: supporting people with dementia and their carers in health and social care [ ] and Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset [ ], the NICE Technology Appraisal Donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease [ ], the European Federation of Neurological Societies (EFNS-ENS) Guidelines on the diagnosis and management of disorders associated with dementia [ ], and the Guidelines (...) published since the last review of this topic. No major changes to recommendations have been made, but the topic has undergone minor restructuring. Previous changes Previous changes June 2015 — minor update. Based on an update in 2015 to the manufacturer's Summary of Product Characteristics (SPC), decreased appetite has been included as a common adverse effect of rivastigmine. April 2015 — minor update. Update to the text to reflect new advice from the Department of Transport on drugs and impaired

2019 NICE Clinical Knowledge Summaries

200. Pharmacological interventions for cognitive decline in people with Down syndrome. (PubMed)

Pharmacological interventions for cognitive decline in people with Down syndrome. People with Down syndrome are vulnerable to developing dementia at an earlier age than the general population. Alzheimer's disease and cognitive decline in people with Down syndrome can place a significant burden on both the person with Down syndrome and their family and carers. Various pharmacological interventions, including donepezil, galantamine, memantine and rivastigmine, appear to have some effect

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2015 Cochrane

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