Cholinesterase Inhibitors

Antidementia Agents

Donepezil

Galantamine

Rivastigmine

Think “Gallantly Down the River“ to remember the centrally acting AChE inhibitors used in the treatment of dementia: Galantamine, Donepezil, and Rivastigmine.

• Mild to moderate AD (first-line)

• Mild to moderate Parkinson dementia

• Lewy body dementia

Reversible cholinesterase inhibition → ↑ ACh concentration at the synaptic gap

ACh concentration improves symptoms in some types of dementia.

• Nausea, vomiting

• Dizziness

• Insomnia

• Cholinergic crisis

• Bradycardia, conduction abnormalities

Cholinesterase inhibitors affect the sinoatrial and atrioventricular nodes and increase the risk of bradycardia, syncope, and heart block.