North East and North Cumbria
ICS Formulary
 
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4 Central nervous system
04-11 Drugs for dementia

Only specialists in the care of patients with dementia (psychogeriatricians and certain neurologists) should initiate treatment.

 


Donepezil
First Choice
  • Only approved for use in accordance with NICE guidance. 
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease

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Galantamine
Formulary
  • Only approved for use in accordance with NICE guidance. 
  • The oral solution is only approved for limited short-term use in the management of hospital patients who are unable to swallow tablets/ capsules. It is not for use in patients whose dementia is so severe that they can no longer swallow tablets.
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease

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Memantine
Formulary
  • Only approved for use in accordance with NICE guidance. 
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease

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Rivastigmine
Formulary
  • Only approved for use in accordance with NICE guidance. 
  • Rivastigmine patches are approved for patients unable to tolerate treatment with oral rivastigmine due to nausea and vomiting, and for patients requiring treatment with an acetylcholinesterase inhibitor who are unable to take oral medication e.g. due to swallowing difficulties or ‘nil by mouth’ prior to surgery.
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease

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Rivastigmine Twice weekly patches Zeyzelf®
Formulary
  • 4.6 mg/24 h , 9.5 mg/24 h transdermal patch
  • Only approved for use in accordance with NICE guidance.
  • Alternative option where once-daily patches are challenging.
  • Prescribe by brand to ensure correct product prescribed and dispensed.

Patients requiring daily doses of higher than 9.5mg/24h should be prescribed daily patches, where the most cost efficient brand should be prescribed.

Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease

Green plus View adult BNF  View SPC online  View childrens BNF