AChE inhibitors

Acetylcholinesterase inhibitors

These drugs inhibit the acetylcholinesterase enzyme mediated breakdown of acetylcholine. Thereby slowing the departure of acetylcholine from the synapse, and virtually supplementing the acetylcholine deficits from the damaged neurons. These agents seem to help patients who are suffering from mild to moderate Alzheimers disease with Mini Mental State Exam's (MMSE's) between 10 and 26. Although the AChEI's are able to give a little bit back to some patients in terms of cholinergic function, they do not stop the pathophysiologic process and the patient continues to decline.

Rivastigmine

is currently used in the Netherlands with starting dosages of 1.5 mg twice daily with meals and can be increased by 1.5 mg after two weeks until the maximum of 6 mg twice daily.

Rivastigmine is generally well tolerated with only a few patients stopping the drug due to GI complaints or CNS effects such as headache, sedation/insomnia, depression or an increase in agitation. These adverse effects can generally be reduced by lowering the dose and titrating upward more slowly.

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Limitations of cholinesterase inhibitors include all the following EXCEPT: