Medications approved for Alzheimer's disease in Canada

What medications are available?

Medications now approved in Canada for Alzheimer's disease may help with symptoms such as changes in language, thinking abilities and movement.

Each medication has a brand name and a generic name.

Aricept™ (brand name) or Donepezil (generic name)
Reminyl ER™ (brand name) or Galantamine (generic name)
Exelon™ (brand name) or Rivastigmine (generic name)
Ebixa^® (brand name) or Memantine (generic name)

It doesn't matter whether the medication is brand name or generic – their effects are the same.

Depending on how severe your symptoms are and how quickly the disease progresses, different medications may be appropriate.

Medications for mild to moderate Alzheimer's:

Donepezil (Aricept™)
Galantamine (Reminyl™)
Rivastigmine (Exelon™)

Medications for moderate to advanced Alzheimer's disease:

Memantine (Ebixa®)
Donepezil (Aricept™)

How do these medications work?

Three of them can help prevent decline in learning and memory

Three of the medications – donepezil (Aricept™), galantamine (Reminyl™) and rivastigmine (Exelon™) – are cholinesterease inhibitors. These medications are can prevent the breakdown of a brain chemical called acetylcholine.

Understand more about acetylcholine:

Acetylcholine is a chemical in the brain thought to be important for learning and memory.
A person with Alzheimer’s has lower levels of acetylcholine than someone without the disease.
By providing an increased concentration of acetylcholine, these medications may temporarily ease or stabilize some of the symptoms of Alzheimer’s.

These medications may be helpful for two to three years, possibly longer. Eventually, the nerve endings die and the medications are no longer effective. Because of that, they are only useful for people in the mild to moderate stages of dementia.

One of them can protect your brain cells

The other medication, memantine (Ebixa^®), is an NMDA receptor antagonist. This medication is thought to work by affecting another brain chemical called glutamate.

Understand more about glutamate:

Glutamate helps send messages between brain cells.
Glutamate is released in excessive amounts when brain cells are damaged by Alzheimer’s.
Memantine may protect brain cells by blocking effects of too much glutamate.

Some specialists recommend adding memantine to one of the cholinesterase inhibitors once a person with Alzheimer’s has progressed from the early and middle stages to the middle and late stages.

Memantine can be prescribed for people in the middle and late stages who can’t tolerate the side effects from a cholinesterase inhibitor.

Please refer to our downloadable brochure for more information: Medications for Alzheimer’s disease: are they right for you?

How can you tell if a medication is helping or hurting?

Potential improvements

Improvements are often subtle and can be hard to detect, even for your doctor or pharmacist. It also may take several months to see the benefits. Some people will benefit more than others.

Improvements may include:

Modest cognitive changes: The person living with Alzheimer's notices improvements in memory, concentration and language.
Subtle behavioural changes: The person living with Alzheimer's is calmer, more engaged in daily activities (such as cooking, bathing and using appliances), more motivated and more communicative.

Some people will not show significant improvement, but they may stabilize for a period of time.

Potential side effects

Medications are usually started at the lowest dose available, which may help minimize side effects. If the person is tolerating the medication, the dosage is usually increased slowly to maximize the benefits of the treatment. To get a full list of side effects, ask your doctor or health-care provider.

If any of these side effects are experienced, contact your doctor or pharmacist as soon as possible.

Some side effects of donepezil, galantamine and rivastigmine:

Gastrointestinal side effects, like nausea, vomiting, diarrhea or loose stools
Loss of appetite and subsequent unintended weight loss
Slowing of heart rate
Dizziness
Falls
Headaches
Nightmares
Sleep disruptions
Note: You may experience insomnia or sleep disruptions depending on the time of day you take this medication. For instance, some experts recommend taking donepezil (Aricept) in the morning for this reason. This is so it won't disrupt sleep for some users at night. Discuss what's best for you with your doctor and pharmacist.

Some side effects of memantine:

Sedation
Muscle cramps
Headaches
Dizziness
Fatigue
Insomnia
Note: As for the other medications listed above, be aware sleep disruptions can be side effects for some. Make sure to discuss any sleep issues and medication interactions or timings with your doctor and/or pharmacist.

Caution is also required in prescribing memantine for people who have problems with their kidneys.

No changes

Because Alzheimer’s is a progressive disease that gets worse over time, noticing no changes in the person’s daily function and behaviour for six months or a year after starting the drug is a positive outcome and a sign that the medication is working.

If the medications are discontinued, the person may lose the benefits and might decline at a rate faster than otherwise expected.

When should you start taking these medications?

If there are no other health conditions that could make taking these medications dangerous for you, doctors generally recommend starting a trial of one of the cholinesterase inhibitors immediately after diagnosis.

If your family doctor is uncomfortable or reluctant to prescribe one of these medications, consider requesting a consultation with a geriatric specialist for another opinion.

For how long should these medications be taken?

If you are benefiting from the medication and can tolerate the side effects, it's often recommended that you continue taking the medication until the final stages.

In other cases, where there is no clear benefit, if there is a safety concern, the side effects are too difficult, or you may just dislike taking the medication, then it may be time to stop treatment. Each experience is unique – consult your doctor to decide what's best.

Are these medications effective for other types of dementia?

Cholinesterase inhibitors (donepezil, galantamine and rivastigmine) were originally developed to treat only Alzheimer’s disease, not for other types of dementia and similar conditions such as mild cognitive impairment (MCI).

However, there may be some cases where these medications are effective, depending on the type of dementia:

Cholinesterase inhibitors, particularly donepezil and rivastigmine, are also commonly used to treat dementia with Lewy bodies and have been reported to reduce visual hallucinations.
Rivastigmine has also been approved to treat dementia brought on by Parkinson’s disease.
There is not enough evidence that supports the use of cholinesterase inhibitors or memantine in people living with vascular dementia or frontotemporal dementia.
However, for people with a combination of Alzheimer’s disease and vascular dementia (known as mixed dementia), cholinesterase inhibitors may be used when Alzheimer’s disease is the main cause, but not to treat vascular dementia on its own.
In the case of MCI, these medications are generally not effective. They do not reduce the risk of MCI progressing to Alzheimer’s disease or another type of dementia.

Important to know:

Dementia affects each person differently. A treatment that works for one person may not work for someone else.

Are these medications covered by your provincial health insurance plan?

Medication coverage varies from province to province and individuals may be required to cover some of the costs associated with these medications.

The person must meet specific criteria in their province to be entitled to have the medications paid for by their provincial medical coverage plan. Check with your province's health plan to find out if you have coverage.

Medication may also be covered by many private insurance plans.

What other treatment options are available?

Medications should only be one part of your overall care. Consider your treatment options:

Some alternative treatments (such as music therapy, aromatherapy, pet therapy, and massage) may be beneficial to people with dementia. However, the lack of evidence supported by research prevents us from determining their effectiveness.
There are potential treatments that may be effective in treating not just the symptoms of Alzheimer's, but perhaps even stop cognitive decline outright. However, plenty of research and testing needs to be done to validate their results. We may still be years away from seeing these new treatments become available to the public.
The most effective treatment that doesn't involve medication? Follow a brain-healthy lifestyle. Taking part in physical and social activities, challenging your brain and making healthy choices are vital to living well with dementia.

For a full list of treatment options currently available to you, please read our print-friendly brochure.

Now that you know the accurate information and realistic expectations about the potential benefits and possible side effects of these medications, talk with your doctor or pharmacist about whether these medications are right for you.

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