OBJECT DRUGS

Cholinesterase Inhibitors:

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

PRECIPITANT DRUGS

Antipsychotics:

• Chlorpromazine (Thorazine)
• Clozapine (Clozaril, etc.)
• Olanzapine (Zyprexa, etc.)
• Perphenazine (Trilafon)
• Proclorperazine (Compazine)
• Quetiapine (Seroquel, etc.)
• Thioridazine (Mellaril)
• Trifluoperazine (Stelazine)

Comment:

The cholinesterase inhibitors used to treat Alzheimer's dementia are cholinergic, while the antipsychotic agents listed above have anticholinergic properties. Thus, one would expect that these antipsychotics would inhibit the efficacy of cholinesterase inhibitors. The clinical evidence suggests that this may occur.

Class 3: Assess Risk & Take Action if Necessary

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