OBJECT DRUGS

Cholinesterase Inhibitors:

• Donepezil (Aricept, etc.)
• Galantamine (Razadyne, etc.)
• Rivastigmine (Exelon)

PRECIPITANT DRUGS

Muscle Relaxants:

• Cyclobenzaprine (Flexeril, etc.)
• Methocarbamol (Robaxin, etc.)
• Orphenadrine (Norflex)

Comment:

The cholinesterase inhibitors used to treat Alzheimer's dementia are cholinergic, while the muscle relaxants listed above have anticholinergic properties. Thus, one would expect that these muscle relaxants would inhibit the efficacy of cholinesterase inhibitors. The clinical evidence suggests that this may occur. Short-term use of these muscle relaxants may be less likely to cause problems.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative: Consider using a muscle relaxant with little or no anticholinergic effects.
• Monitor:If the combination is used, monitor for evidence of reduced efficacy of the cholinesterase inhibitor.