4.1 Dementia

Page content

Page breadcrumb

Print this page

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Traffic light status (TLS) explained:

Green: Routine prescribing within licensed indication
Amber 1: specialist recommendation followed by GP initiation and continuation
Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
Amber 3: specialist initiation and stabilisation followed by GP continuation
Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
Red: Hospital or specialist prescribing only

Important Notes:

Behavioural and psychological symptoms can be part of the dementing process, but it is important to exclude any intercurrent illness.

Behavioural and psychological approaches are important and the use of medication has a lower profile.

If medication is used, the rule of start low, go slow, monitor effects frequently applies.

It is important to review any drug at regular intervals and assess whether it can be stopped as the treatment symptoms may have remitted.

Anticholinesterases

National Guideline:

Use as per NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease (March 2011)

Prescribers must seek prior approval from the Individual Funding Request (IFR) panel for use of acetylcholinesterase inhibitors in Lewy Body Dementia and in Parkinsons Disease Dementia.

Donepezil hydrochloride (Amber 1)

Tablets 5mg, 10mg
Orodispersible tablets 5mg, 10mg

Note:

Only use dispersible tablets where the patient has proven swallowing difficulties.

Galantamine (Amber 1)

Capsules, Modified Release 8mg, 16mg, 24mg
Tablets 8mg, 12mg
Oral solution 4mg/mL

Rivastigmine (Amber 1)

Capsule 1.5mg, 3mg, 4.5mg, 6mg
Oral solution 2mg/mL
Patches 4.6mg/24 hours, 9.5mg/24 hours

NMDA Receptor Antagonists

Memantine hydrochloride (Amber 1)

Tablets 10mg, 20mg, initiation pack
Oral solution pump pack 5mg per actuation (10mg per mL)

Traffic light status (TLS) explained:

Green: Routine prescribing within licensed indication
Amber 1: specialist recommendation followed by GP initiation and continuation
Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
Amber 3: specialist initiation and stabilisation followed by GP continuation
Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
Red: Hospital or specialist prescribing only