Cholinesterase Inhibitors

Reviewed by: HU Medical Review Board | Last reviewed: August 2023

Medication cannot stop the progression of Alzheimer's or cure the disease, but it may help reduce symptoms in some people. Several kinds of drugs are approved to treat the cognitive symptoms of Alzheimer’s disease, including drugs called cholinesterase inhibitors.1

How do cholinesterase inhibitors work?

Cholinesterase inhibitors work by helping the brain's communication pathways function better. In our brains, there is a chemical called acetylcholine that helps with memory, thinking, and learning. But in Alzheimer's, this chemical can become scarce.1,2

Cholinesterase inhibitors step in to stop another chemical, called cholinesterase, from breaking down acetylcholine too quickly. This means there is more acetylcholine available to support our brain's activities. Think of it like keeping the important messages in your brain from disappearing too fast. This can help with memory and thinking, slowing down symptoms of Alzheimer’s.1,2

Examples of cholinesterase inhibitors

In the United States, there are several cholinesterase inhibitors approved for treating Alzheimer's disease. These include:1,2

  • Donepezil (Aricept®): This is one of the most commonly prescribed cholinesterase inhibitors. It is available in different strengths and can help improve memory, thinking, and daily living activities for some people with Alzheimer's.
  • Rivastigmine (Exelon®): Another cholinesterase inhibitor that comes in various forms, such as capsules, patches, and liquid. It can also help with cognitive symptoms and may slow down Alzheimer’s progression for a while.
  • Galantamine: This cholinesterase inhibitor is available in different forms, including tablets and liquid. It can aid in improving memory and other cognitive functions in some people with Alzheimer's.

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. Common side effects of cholinesterase inhibitors can include:1-3

  • Nausea or upset stomach
  • Loss of appetite
  • Dizziness or fainting
  • Diarrhea
  • Headache
  • Tiredness or weakness
  • Muscle cramps
  • Trouble sleeping

Not everyone will experience these side effects. And some people might have a different reaction altogether. These are not all the possible side effects of cholinesterase inhibitors. Talk to your doctor about what to expect when taking cholinesterase inhibitors. You also should call your doctor if you have any changes that concern you when taking cholinesterase inhibitors.3

Other things to know

If you have heart, kidney, or liver problems, tell your doctor about them before taking these medicines. These drugs can affect how your body handles things, and your doctor needs to know to give you the right dosage.2

If you have stomach problems like ulcers or reflux, talk to your doctor. Cholinesterase inhibitors might cause stomach-related side effects.2

These drugs do not stop the brain damage that occurs in Alzheimer’s disease. They also do not reverse the damage that has already occurred.2

These drugs can lose their ability to work over time for some people with Alzheimer’s disease. This may happen as the disease progresses. Talk to your doctor about this and ways to manage this over time.2

While cholinesterase inhibitors can help manage certain symptoms, they may not work the same for everyone. Always consult your doctor to decide the best treatment approach.1,2

Before beginning treatment for Alzheimer's disease, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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