Rivastigmine (Exelon)
Rivastigmine (Exelon) received FDA approval to treat Alzheimer’s disease in May 2000, and it is a cholinesterase inhibitor that is very similar to donepezil (Aricept) in its clinical effects. Rivastigmine is given in doses of 3 to 12 mg daily but has to be taken twice (morning and evening), unlike the once-a-day dose for donepezil. Rivastigmine’s common side effects include stomach upset, headache, and fatigue. More research is needed to find out if Exelon possesses any significant advantages over Aricept, but current information suggests few differences.
Other Cholinergic Compounds for Clinical Use
Currently, several pharmaceutical companies are trying to develop other cholinergic compounds to treat Alzheimer’s disease (and mild memory loss), some of which are likely to be approved by the FDA during 2000–2001. Galantamine (Reminyl), which was provisionally approved by the FDA in late 2000, is very similar to donepezil (Aricept) and rivastigmine (Exelon) in its clinical effects. Galantamine is recommended in doses of 16 to 24 mg per day.
Nicotine Is a Cognitive Enhancer
There is another cholinergic system— nicotinic— in the brain that utilizes nicotine as its main neurotransmitter. Yes, this is the same nicotine that causes addiction to cigarettes! Nicotine stimulates the release of endorphins, which are the brain’s natural morphinelike substances, and dopamine, which is involved in stimulating the reward-pleasure and arousal systems. The activating properties of nicotine, which make people more alert and aroused, may partly account for its
addictive potential.
Nicotine receptors are deficient in the brains of patients with Alzheimer’s disease. Initial studies using the nicotine skin patch in Alzheimer’s patients were promising, but the latest studies have been
negative. A broader question is whether nicotine can treat mild memory loss or prevent age-related memory loss. Early population-based studies suggested that smokers were less likely to develop Alzheimer’s disease, but recent work has discounted this theory. Simultaneous administration of nicotinic and muscarinic compounds has never been attempted in any clinical trial, largely because of the fear of increased cholinergic toxicity. At this stage, the data on nicotine are insufficient for me
to recommend it as a therapeutic or preventive strategy against memory loss.
Taken From: The Memory Program How to Prevent Memory Loss
and Enhance Memory Power
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