Drugs to treat Alzheimer’s Disease (AD) represent a major concern for caregivers of patients with the disease. A new prescription drug, Exelon®, has just been approved in the United States. You may want to know how Exelon® compares to other drugs (examples: Aricept®, Cognex®) available to treat AD.

Exelon®, Aricept® and Cognex®:

You should know that Exelon®, Aricept® and Cognex® all belong to a class of drugs called the cholinesterase (pronounced colon-EST-erase) inhibitors. All work by increasing the brain’s supply of acetylcholine, a nerve communication chemical that is deficient in people with Alzheimer’s Disease (AD). These drugs may improve memory, behavior, and the ability to perform simple tasks in those with mild to moderate Alzheimer’s. As AD progresses, treatment with these drugs becomes less effective. These drugs do not cure Alzheimer’s. There is no known way to predict who will benefit from these drugs.

Exelon®, Aricept® or Cognex® may help delay the time until skilled care is needed for the person affected with AD by roughly 6–12 months. Sometimes a "lack of noticeable improvement" is noted and can be frustrating for caregivers and doctors. However, a lack of improvement does not mean the drug is not working. The benefit of these medications may be a delay in further decline of memory or function. If the medication is discontinued, the family may notice a worsening of the symptoms of AD. For this reason, the doctor will often continue the AD drug even if memory or function improvements are not noticeable, until the patient has progressed into the later stages of AD.

Exelon®, Aricept®, and Cognex® differ in how they are taken, their interactions with other medications, and their side effects. The doctor decides which of these drugs to use based on these differences, as well as previous responses if the person has taken one of these drugs in the past. For example, if a patient experienced side effects with Cognex® but obtained memory improvement, the doctor may try one of the other drugs; the other drugs are likely to produce similar benefits with less side effects.

Aricept® is taken once daily at bedtime, which is easy for a patient or caregiver to remember. Aricept® may be taken with or without food. Side effects are usually mild and will decrease with continued use. Common side effects include diarrhea, nausea, vomiting, difficulty sleeping, fatigue, and loss of appetite. Aricept® may interact with some medications that are broken-down by the liver. Individuals may need to receive special monitoring for drug-drug interactions if they take other medications with Aricept®. The average price for Aricept® is roughly $130 per month.

Cognex® must be taken four times per day on an empty stomach (either 1 hour before or 2 hours after meals). Due to the more complicated instructions for use, a patient with AD may easily forget to take a dose of Cognex® during the day. The most serious side effects of Cognex® are changes in blood tests for liver function. For this reason, blood tests must be checked often. In some cases, if blood tests are not normal, the doctor must adjust the dose of Cognex® or stop the drug. Common side effects include nausea, vomiting, diarrhea, abdominal pain, indigestion, and skin rash. In some people, these side effects make it difficult to continue the drug. Cognex® may interact with medications that are broken-down by the liver; patients taking other medications along with Cognecx® may need additional monitoring. The average price for Cognex® is roughly $147 per month.

Exelon® must be taken twice daily with meals. Taking Exelon® with food helps to decrease side effects like nausea, so it is important to take the medication with food. Administration with meals can be a challenge if the individual does not want to eat. The common side effects of Exelon® are nausea, vomiting, fatigue, loss of appetite and weight loss. Exelon® did not cause liver function changes in studies, but occasional blood testing is recommended. As with Aricept®, the side effects of Exelon® are usually mild and decrease with continued treatment. Exelon® is somewhat unique; it is less likely than the other AD medications to cause significant interactions with other drugs. The average price for Exelon® is roughly $130 per month.

Exelon® is very similar to other medications already available for treating AD. Patients and their caregivers or families should discuss the potential benefits, risks and costs of medications with their doctors before deciding whether to try a particular drug. If you have questions about the drug(s) your loved one is taking, check with your doctor. Each person with AD is an individual, and a drug that works well for one person may not be what works well in another.