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How It Works

Cholinesterase inhibitors increase the level of a brain chemical called acetylcholine. People with Alzheimer's disease and related conditions have decreased brain levels of this neurotransmitter. Increasing the amount of acetylcholine appears to slow mental decline in people with Alzheimer's disease.

These medicines help the brain cells work better but do not stop or reverse the destruction of brain cells and loss of acetylcholine that occur in Alzheimer's disease. They do not prevent the disease from getting worse but may slow the progression of symptoms.

Why It Is Used

Cholinesterase inhibitors may be used to treat some symptoms of Alzheimer's disease. They also may be used in other types of dementia, such as dementia with Lewy bodies and multi-infarct dementia.

How Well It Works

Cholinesterase inhibitors may produce small improvements in memory and general ability to function.¹ For example, the person may be able to remember friends' names better and be able to dress himself or herself with less difficulty.

Cholinesterase inhibitors do not help everyone who has Alzheimer's disease. It is believed that as the disease progresses, the medicine eventually may stop working.

The various cholinesterase inhibitors have similar effects on memory and cognitive function, so the choice between medicines may be based on side effects, dosing schedules and ease of use, individual response to a particular medicine, or other factors.

Side Effects

In general, most people seem to tolerate cholinesterase inhibitors very well. The most common side effects are:

• Nausea.
• Diarrhea.
• Vomiting.
• Indigestion.
• Abdominal pain.
• Loss of appetite and weight loss.

Less common side effects include insomnia, fatigue, and muscle cramps. Side effects tend to be mild and usually go away within a few weeks after treatment with the medicine is started.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Cholinesterase inhibitors do not work for everyone who has Alzheimer's disease, but they are helpful for some people. They may be a reasonable option for those who understand the risks and costs and feel the possible benefits are worth it.

Most studies of cholinesterase inhibitors for people with Alzheimer's disease found that the benefits of taking these medicines are small.^{2, 3}

Side effects seem to be milder and occur less often with donepezil or galantamine than with rivastigmine.

Experts agree that reducing problems with memory loss may help people with Alzheimer's disease live better. In some cases, reducing these problems may help people live more independently for a longer period of time.

Rivastigmine (Exelon) can now be given through a skin patch. Skin patches release medicine into the blood at a steady level and may reduce side effects. And when a person uses a skin patch, it's easier for caregivers to make sure the person is getting his or her medicine properly.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

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