Alzheimer's Drugs

Background

Alzheimer’s is a disease that destroys cells in the brain. Over time, people with Alzheimer’s become unable to reason, to learn, or to remember. Their behavior and personality also change. Alzheimer’s is the most common cause of dementia, or mental decline, in older people. More than five million Americans have Alzheimer’s.

There are drugs that are used to treat Alzheimer’s. The drugs may slow mental decline and ease symptoms in some people. However, most people do not get much help from them. Several other treatments have also been studied. These include dietary supplements, ibuprofen (brand names Advil and Motrin), and some cholesterol drugs (statins). But none has been shown to help.

There are four main drugs used to treat Alzheimer’s. A fifth drug, tacrine (brand name Cognex), is rarely used because it can cause serious liver damage. Studies show that the drugs usually do not relieve symptoms or slow down the disease. As the disease becomes worse, the drugs are even less likely to help.

To help you and your doctor evaluate these medicines, Consumer Reports has analyzed the drugs in this category based on their effectiveness, safety, dosing convenience, and cost. This brief is a summary of a 20-page report you can access on the Internet at CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site. Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the states Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need an Alzheimer's Drug?

The medications used to treat mental decline in people with Alzheimer’s disease are not particularly effective. When compared to a placebo, most people who take one will not experience a meaningful benefit. And once taken, it is rare for a person to experience a notable delay in the worsening of their symptoms over time. (The medications do not treat Alzheimer’s disease directly, only its symptoms.)

Yet, there is no way to predict who will get a benefit from one of the five drugs approved to treat Alzheimer’s disease and who will not. So the decision to try an Alzheimer’s medication should be based on whether any potential benefit is worth the cost and the risk of side effects.

  • Cost. Averaging about $177 to more than $400 per month, the Alzheimer’s disease drugs are costly and may not be worth it if a person takes many other medications for other health conditions. This is true even if insurance or Medicare coverage helps pay since out-of-pocket payments can still be quite steep.
  • Side effects. One of the Alzheimer’s medications, tacrine (Cognex), poses a risk of liver damage, so it is now prescribed only rarely. The four other drugs can cause several side effects. Most are minor, such as nausea, vomiting, dizziness, loss of appetite, muscle cramps, tremor, and weight loss. But for some people, these adverse effects might persist or be intolerable. These medications can also pose more serious side effects in rare cases, such as a slow heart beat, heart block, gastrointestinal bleeding and ulcers, and possibly convulsions or seizures.

Stages of Alzheimer's

Not Alzheimer’s

Early Stage

Middle Stage

Late Stage

  • Forgetting things occasionally
  • Misplacing items, like keys, eye glasses, bills, paperwork
  • Forgetting the names or titles of some things, like movies, books, people’s names
  • Some reduction in ability to recall words when speaking
  • Being “absent-minded” or sometimes hazy on details
  • ”Spacing out on things,” such as appointments

  • Short-term memory loss, usually minor
  • Being unaware of the memory lapses
  • Some loss, usually minor, in ability to retain recently learned information
  • Forgetting things and unable to dredge them up, such as the name of a good friend or, even, family member
  • Function at home normally with minimal mental confusion, but may have problems at work or in social situations
  • Symptoms may not be noticeable to all but spouse or close relatives/friends

  • Short-term memory loss deepens, may begin to forget conversations completely, or names of loved ones
  • Mental confusion deepens, trouble thinking logically
  • Some loss of self-awareness
  • Friends and family notice memory lapses
  • May become disoriented, not know where you are
  • Impaired ability to perform even simple arithmetic
  • May become more aggressive or passive
  • Difficulty sleeping
  • Depression

  • Severe cognitive impairment and short-term memory loss
  • Speech impairment
  • May repeat conversations over and over
  • May not know names of spouse, children, or care givers, or what day or month it is
  • Very poor reasoning ability and judgment
  • Neglect of personal hygiene
  • Personality changes; may become abusive, highly anxious, agitated, delusional, or even paranoid
  • Needs extensive assistance with activities of daily living

Sources: Multiple, including the Alzheimer’s Association

Our Recommendations

Because most people who take an Alzheimer’s medication will receive no meaningful benefit, together with the relatively high price tag and the risk of rare but important safety concerns, we are unable to choose any of these drugs as a Best Buy. However, we realize that many people will want to try one of these medications if somebody they care for is suffering from Alzheimer’s disease. In that case, it makes sense to try one that has the lowest rate of side effects and is the least expensive since none of the medications has been shown to be more effective than the others. Generic donepezil and generic galantamine meet both criteria. Both have a lower risk of adverse effects and higher tolerability than the other medications, and since they are generic, their price is significantly less. But if the person taking the drug does not show signs of improvement within three months, it is unlikely that they ever will, so the drug should then be stopped.


This report was updated in May 2012.

Cost Comparison

Generic Name and Dose

Brand Name

Frequency of Use per Day1

Average Monthly Cost2

Donepezil tablet 5 mg

Aricept

One

$363

Donepezil tablet 5 mg

Generic

One

$208

Donepezil tablet 10 mg

Aricept

One

$352

Donepezil tablet 10 mg

Generic

One

$203

Donepezil dissolvable tablet 5 mg

Generic

One

$240

Galantamine tablet 4 mg

Generic

Two

$196

Galantamine tablet 8 mg

Generic

Two

$183

Galantamine sustained-release capsule 8 mg

Generic

One

$177

Galantamine sustained-release capsule 16 mg

Generic

One

$179

Memantine tablet 5 mg

Namenda

Two

$269

Memantine tablet 10 mg

Namenda

Two

$266

Memantine oral solution 10 mg/5 mL

Namenda

Two

$489

Rivastigmine capsule 1.5 mg

Generic

Two

$222

Rivastigmine capsule 3 mg

Generic

Two

$224

Rivastigmine capsule 6 mg

Exelon

Two

$316

Rivastigmine capsule 6 mg

Generic

Two

$230

1. Frequency of use reflects typical dosing; some products may be used more or less frequently.

2. Prices reflect nationwide retail average for January 2012, rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs based on data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumer Reports is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, noncommercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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