Treating Alzheimer’s disease with cholinesterase inhibitors to slow the progression of symptoms

Last Updated: July 25, 2019


Cholinesterase inhibitors are commonly prescribed to individuals with Alzheimer’s disease and other forms of dementia in order to treat the symptoms of the disease. These types of medications may delay the progression of memory and language loss, as well as impaired judgment and thinking.

For individuals with dementia, brain function decreases in part because their brain cells lose the ability to communicate well. Cholinesterase inhibitors act to increase levels of the neurotransmitter acetylcholine, a chemical that helps brain cells communicate. (Persons with dementia have lower levels of acetylcholine). A person taking a cholinesterase inhibitor may be better able to remember names and details, or perform activities with fewer problems.


Types of Cholinesterase Inhibitors

There are 3 main cholinesterase inhibitors on the market:

1. Aricept® (generic name: donepezil)
2. Razadyne®, formerly known as Reminyl (generic name: galantamine)
3. Exelon® (generic name: rivastigmine)


 Did You Know: Cognex® (generic name: tacrine) a cholinesterase inhibitor, was the first medication approved by the FDA to treat Alzheimer’s. However, it was discontinued in 2013 due to serious side effects, including liver damage.


These medications are typically prescribed to individuals in the early to middle stages of dementia. Aricept® has been approved to treat severe dementia as well. It is important to remember that these medications only slow the progression of dementia and Alzheimer’s disease. They do not stop or reverse its course. These medications typically help for only months to a few years and may not work as well once the disease progresses. The effect of these medications, and how long they are effective, varies on an individual basis. In addition, cholinesterase inhibitors do not appear to benefit individuals with frontotemporal dementia (FTD), since this disease affects the brain in a different way than Alzheimer’s disease and Lewy body dementia.

In general, individuals who use cholinesterase inhibitors experience few side effects. The most commonly experienced side effects are gastrointestinal problems, such as nausea, diarrhea, vomiting, and loss of appetite.

Cholinesterase inhibitors are covered, with quantity limits, under Medicare Part D and Medicare Advantage, and the generic versions of these drugs are covered under almost all Medicare plans.