Starting and maximum doses

Dosage

Comments

Start: 5 mg daily (2.5 mg for very frail persons)

Max: 10 mg daily

Increase to 10 mg daily after 4 weeks

(in the very frail 2.5 mg daily for 2 weeks then 5 mg daily for 4 weeks; 10 mg later if tolerated)

GI adverse effects in ~10% of patients, syncope, falls, worsening cardiac conduction (avoid with severe bradycardia, heart blocks) night cramps, can disturb sleep

Start: 8 mg daily

Max: 32 mg daily

Increase to 16 mg daily after 4 weeks, then 24 mg daily after another 4 weeks if tolerated

GI adverse effects in ~10%, syncope, falls, worsening cardiac conduction (avoid with severe bradycardia, heart blocks)

Oral

Start: 1.5 mg bid (1.5 mg daily for very frail persons)

Max: 6 mg bid

Increase to 3 mg bid after 4 weeks, 4.5 mg bid after another 4 weeks, then 6 mg bid after another 4 weeks if tolerated (in the very frail, 1.5 mg daily for 2 weeks, then 1.5 mg bid for 4 weeks, then 3 mg bid for 4 weeks, and increments of 1.5 mg bid each 4 weeks)

GI adverse effects in ~10%, syncope, falls, worsening cardiac conduction (avoid with severe bradycardia, heart blocks)

Transdermal patch

Start: Exelon patch 5 (4.6 mg every 24 hours)

Max: Exelon patch 15 (13.3 mg every 24 hours)

Starting dose patch 5, increase to patch 10 after 4 weeks

Transcutaneous patch delivers rivastigmine with much lower incidence of GI adverse effects

Start: 5 mg daily

Max: 10 mg bid

After 1 week increase to 5 mg bid; after 1 more week 10 mg every morning, 5 mg every afternoon; after 1 more week 10 mg bid

Occasional headache, dizziness

Donepezil, galantamine, rivastigmine are cholinesterase inhibitors.

Memantine is an NMDA receptor agonist.