Alzheimer’s Disease Medication

Medically Reviewed by Jabeen Begum, MD on July 03, 2024
Written by Rachel Reiff Ellis
12 min read

Alzheimer’s disease doesn’t have a cure, and there aren’t yet treatments that can stop its progression, but there are Alzheimer’s drugs that can help people with their memory and thinking skills for a short time. 

When someone you care about has dementia, memory loss affects their daily life. You want to help them, and there are medicines that can help.

The goal of Alzheimer’s drugs is to slow down the decline in thinking skills and improve quality of life. The best medication for Alzheimer’s depends on your loved one’s condition, how advanced the disease is, and other factors. 

This was the first Alzheimer’s drug approved by the FDA in decades. But its maker, Biogen, announced in January 2024 that it’ll no longer make the drug after November 2024. The decision was not based on safety or efficacy concerns, but instead was made so that the company could “reprioritize its resources in Alzheimer's disease.” 

How does aducanumab work?

Aducanumab is a monoclonal antibody that lessens the buildup of things called amyloid plaques in your brain. These plaques are part of what leads to the memory loss that comes with Alzheimer's disease.

For people with mild cognitive impairment or early Alzheimer's disease, the drug appears to slow down the progression of the disease.

Side effects of aducanumab

The most common appears to be something called ARIA: amyloid-related imaging abnormalities. One study suggests that 41% of people who take this drug will get ARIA. These problems include temporary swelling in the brain and small areas of bleeding. 

This drug is also approved to treat the early stages of Alzheimer's disease. It may be prescribed as an IV you get every 2 weeks.

How does lecanemab work?

Lecanemab is a monoclonal antibody that lessens the buildup of amyloid plaques in your brain.

For people with mild cognitive impairment or early Alzheimer's disease, the drug appears to slow down the progression of Alzheimer's disease.

Side effects of lecanemab

Along with possible flu-like symptoms, patients may also get ARIA. There is also the possibility of temporary swelling in the brain and small areas of bleeding. 

In July 2024, the FDA approved another monoclonal antibody to treat the course of the disease. You take it as an IV every 4 weeks. 

How does donanemab work?

This drug is for people with mild cognitive impairment or mild dementia related to Alzheimer’s. Donanemab helps reduce the buildup of amyloid plaques in your brain. 

Side effects of donanemab

The most common side effects of this drug are headaches and swelling in the brain that typically resolves over time. You may also have other IV-related side effects such as flu-like symptoms, nausea, vomiting, changes in blood pressure, an allergic reaction, and swelling where you get the IV.

If your loved one has Alzheimer’s disease that isn’t too severe yet, their doctor might prescribe them a cholinesterase inhibitor. If they have another type of dementia, their doctor may consider it, too.

Alzheimer’s damages nerve cells, which lowers the amount of acetylcholine in your brain. Acetylcholine is a “messenger chemical” that’s important for learning, memory, and mood. 

Cholinesterase inhibitors help boost the amount of acetylcholine you have so more messages get through.

How do cholinesterase inhibitors work?

Scientists think these Alzheimer’s drugs prevent acetylcholine from breaking down. This means more of the messenger chemical is available for healthy cells. Cholinesterase inhibitors also appear to delay the worsening of Alzheimer’s symptoms.

These medicines include:

  • Donepezil (Aricept). Doctors prescribe this cholinesterase inhibitor to treat all stages of Alzheimer’s. You take it as a pill once a day. 
  • Galantamine (Razadyne, Razadyne ER, Reminyl). This option is approved to treat mild to moderate Alzheimer’s disease. You take it as an extended-release pill once a day or as a pill or liquid twice a day.
  • Rivastigmine (Exelon). You take this drug either as a pill twice a day, for mild to moderate Alzheimer’s, or wear it as a patch for all stages of Alzheimer’s. 

Most people with Alzheimer’s who take one of these medications get some benefit from it, including less anxiety, improved motivation, and better concentration and memory. And some are able to continue with their regular activities.

But the improvements don’t seem to last long – about 6 to 12 months. They mainly delay the worsening of the disease for a period of time.

All three medicines work similarly, but one might work better for your loved one than it does for someone else.

Side effects of cholinesterase inhibitors

Most people don’t have side effects when they take cholinesterase inhibitors, but some do have:

  • Nausea
  • Vomiting
  • Loss of appetite
  • More frequent bowel movements
  • Bruising
  • Muscle cramps
  • Headaches
  • Fatigue
  • Insomnia

If your loved one has moderate to severe Alzheimer’s, their doctor may prescribe them memantine (Namenda) for their symptoms.

How does memantine work?

Memantine could help improve memory, attention, reasoning, and language. Your doctor may also prescribe it with donepezil (Aricept). Memantine helps balance glutamate, which is another “messenger chemical” involved in memory and learning.

Studies show that memantine can curb delusions (believing things that aren’t true), hallucinations (seeing things that aren’t there), agitation, aggression, and crankiness. It can also help your loved one with disorientation and make their daily activities easier.

Memantine comes in immediate-release tablets, extended-release tablets, and oral drops. You typically take the immediate-release tablets or drops twice a day. You take the extended-release tablets once a day.

Side effects of memantine

The side effects aren’t as bad or as common as the side effects of cholinesterase inhibitors, and include:

Retail price is around $120 for 60 tablets, but that’s rarely what patients pay for the drug. Prices are a moving target based on your insurance coverage, where you live, the pharmacy you use, whether you can get financial assistance, and whether you use discount programs like GoodRx. 

Memantine is covered 100% by Medicare prescription drug plans.

It may take months before memantine works well enough to notice a difference. For some people, it may be difficult to tell if the drug is working, because it may simply be keeping dementia symptoms from getting worse. 

Rivastigmine is used to treat mild to moderate dementia that comes with Alzheimer's disease. If you take it in patch form, it can help treat severe Alzheimer’s, too. 

How does rivastigmine work?

Rivastigmine is a type of drug called a cholinesterase inhibitor, or acetylcholinesterase inhibitor. Nerve cell damage caused by Alzheimer’s disease decreases the amount of a chemical messenger in the brain called acetylcholine (ACh). 

Rivastigmine helps prevent the breakdown of ACh, so it can build up and have a greater effect. 

You take this twice a day as a capsule you swallow. It also comes as a patch you stick to your skin and change daily.

Side effects of rivastigmine

The most common side effects of this drug include:

  • Bladder pain
  • Bloody or cloudy urine
  • A hard time peeing or burning when you pee
  • Needing to pee frequently
  • Lower back or side pain

Some people may also have:

  • Blurred vision
  • Dizziness
  • Headache
  • Loss of bladder control
  • Nervousness
  • Pounding in the ears
  • Slow or fast heartbeat

Prescription costs will vary greatly from person to person, depending on coverage and other things. A supply of 30 patches can cost as much as $506, but discount programs can reduce this cost. 

Almost all Medicare prescription plans cover the drug. 

Your doctor may prescribe this drug to treat mild to moderate dementia caused by Alzheimer’s. You take it either twice a day as a tablet you swallow, or once a day as an extended-release capsule.

How does galantamine work?

Galantamine is also a cholinesterase inhibitor, and it helps prevent the breakdown of acetylcholine in the brain to improve messages to nerves. 

Side effects of galantamine

When you take this drug, you may feel dizzy. Galantamine can also cause:

  • Loss of appetite 
  • Nausea
  • Diarrhea or vomiting 
  • Headaches 
  • Feeling tired 
  • Trouble sleeping

Your cost for the drug will vary, based on your insurance coverage and other things. Sixty tablets can retail for $137, but with discount plans, the cost may be as little as $31.

Almost all Medicare prescription plans cover galantamine.

Brexpiprazole is a medication doctors prescribe specifically for agitation in Alzheimer’s. It’s a type of drug called an atypical antipsychotic. You take it as a tablet by mouth once a day. 

How does brexpiprazole work?

The drug acts on chemical messengers in the brain called neurotransmitters. By rebalancing dopamine and serotonin in your brain, brexpiprazole reduces the amount of agitation these neurotransmitters cause. 

Side effects of brexpiprazole

When you take brexpiprazole, you may have side effects such as:

  • Restlessness
  • Weight gain
  • Changes to your cholesterol 
  • A drop in blood pressure when you stand
  • Dizziness
  • Trouble regulating your temperature

Brexpiprazole is only available in name-brand form (Rexulti), so it can cost as much as $1,700 for 30 tablets. Your price will vary, based on your insurance coverage and other factors. 

All Medicare prescription plans cover brexpiprazole.

Researchers are constantly working on new drugs to help treat the symptoms of Alzheimer’s and potentially modify the disease itself. In 2023, there were 187 clinical trials testing 141 drugs for Alzheimer’s. The FDA approved two related to Alzheimer’s disease: lecanemab (Leqembi) and brexpiprazole.

So far in 2024, there are 164 clinical trials taking place to test 127 drugs for Alzheimer’s.

Of those drugs:

  • 76% are disease-modifying treatments that aim to slow the decline of memory.
  • 34% are biological therapies given as an IV or through some other injection.
  • 12% are cognitive-enhancing agents that are intended to improve memory.
  • 13% are drugs for behavioral symptoms, such as agitation.
  • 31% are repurposed agents approved for other diseases, such as cancer or Parkinson’s disease.

For a person with Alzheimer's, taking medication by mouth can be a challenge. For example, they might not recognize that a pill in their mouth is medicine and that they should swallow it. If this happens, you could ask their doctor or pharmacist if it comes in liquid form or in tablets that dissolve.

If your loved one finds it hard to swallow a pill, there may be a physical reason. For example, if their mouth is dry, have them drink a little water, juice, or coffee first.

If that doesn't work and the medicine doesn't come in another form, ask the doctor or pharmacist if you can crush tablets or caplets, or open capsules and sprinkle the pellets into food or liquid. But you shouldn’t do this with medicines that dissolve over time, called sustained-release medications, so be sure to check first.

If your loved one is in the early stages of Alzheimer’s disease, they’re probably used to taking their own medication. They may become unreliable and need help, but they may want to stay in charge of their pills. If so, it’s very important that they do it safely.

You can do several things to help with that:

  • Use a pill organizer box that you fill up once a week. Store the bottles of labeled medications somewhere safe. If they take medicines more than once a day, use a box that has sections labeled a.m. and p.m.
  • Make a routine to help them remember to take their medicine.
  • Try to fit the medication schedule to their daily routine.
  • Use a reminder like an alarm clock or a daily phone call to help them remember their medicine when you can't be there.
  • If you don’t think they can safely handle their medicines on their own, try to work as a team. Talk with them about what reminders and assistance they would like.

It’s common for people in the early stages of Alzheimer’s to take medications for other conditions, but not take the ones for their Alzheimer’s. That’s because they focus on the condition they already have and don’t see a need to take more medicine for another.

In the later stages of dementia, you’ll need to take charge of your loved one’s medications. These steps can help that go smoothly:

  • Read labels. Know what all the medications are for and how your loved one should take them.
  • Be sure your loved one is only taking medicine they really need and that the dose is right. Have their doctor go over the list about every 6 to 12 months. They may be able to stop the ones they don’t need or change a dose. This means your loved one may be able to take fewer medications and may have fewer side effects.
  • Keep an up-to-date list of all medications in an easy-to-find place. Be sure it has the name of everything your loved one takes. This includes prescriptions, vitamins, herbals, and supplements. It should also have the dose for each one and how and when to take it.
  • Know the risks, benefits, and potential side effects of each one.
  • Make sure they take the right one at the right time.
  • Watch for side effects.
  • Know the risks of how each one might react to foods, supplements, and nonprescription medications.
  • Watch to see that your loved one doesn’t take their medicines without your knowledge.
  • Be sure to refill their prescriptions.
  • Ask the doctor or pharmacist to make the medication list simpler. They might be able to cut down on how many medicines your loved one has to take or the number of times a day they take it.
  • When you give them medicine, talk to them simply and clearly. Say something like, “Here’s the pill for your arthritis. Put it in your mouth." Hand them a glass of water and say, "Have a drink of water to help the pill go down.”
  • If they won’t take their medication, don't argue or fight. Instead, stop and try to find out why. Maybe their mouth hurts or the medication tastes bad. They may not remember how to swallow a pill or what it's for. It may help to remind them that it’s the pill they asked for to ease pain, or that someone they trust thinks it will help. If they still won’t take it, try again later.
  • If they keep refusing, ask their doctor to see if there’s a physical cause. The doctor may also show you an easier way to give it, such as in a liquid or a tablet that dissolves.
  • To prevent an accidental overdose, keep all medications in a locked drawer or cabinet.
  • If you can't be there when they take their medications, get someone else to help.

If your loved one misses a dose, don't worry. Just take the next dose at the normal time and in the normal amount. Never give two doses at once. This more than doubles the risk of side effects. If your loved one misses medications often, talk about it with their doctor.

If your loved one's doctor prescribes a new medication, you could ask:

  • What is its name? Does it go by any other names?
  • Why have you prescribed this?
  • Do they have to take this medication? Are there any alternatives?
  • How often and at what time of day should they take it?
  • Should they take it with food or on an empty stomach?
  • Are there any side effects that I should watch for?
  • How much does it cost? Are there less costly or free alternatives?

Current Alzheimer’s drugs don’t reverse the disease, but they can help some people with their memory and thinking skills for a short time. There are different types of drugs available, including options for reducing agitation, improving communication in the brain, and making thoughts clearer. Your loved one will need help to be sure they take their medications correctly. 

What is the best drug to improve memory?

The best drug to improve memory depends on how severe the memory loss is and what the cause is. Some options for dementia-related memory loss include cholinesterase inhibitors, glutamate regulators, and a combination of the two drugs.

What vitamin is best for brain memory?

Some research suggests that certain vitamins – such as B1 (thiamin), B9 (folic acid), and B12 – and omega-3 nutrients might support good brain function. More studies are needed to draw conclusions that these or other supplements can directly boost memory.

What is the best medication for Alzheimer's?

The Alzheimer’s drug that works best depends on many things, including the stage of the Alzheimer’s disease and how the body interacts to the drug. Most people with Alzheimer’s take cholinesterase inhibitors, memantine, or brexpiprazole.