Medications:

• Donepezil (Aricept)
• Rivastigmine (Exelon, patch available)
• Galantamine (Reminyl ER)
• Pyridostigmine → for MG

Mechanism of Action: Increases acetylcholine levels in the brain by inhibiting its breakdown, supporting communication between nerve cells.

Indication:

• Mild to moderate AD - Alzheimer’s Disease
• Pyridostigmine → MG - Myasthenia Gravis

A/E: Increases cholinergic functions

1. Gastrointestinal (typically improve with time)
   • Nausea
   • Vomiting
   • Diarrhea
   • Loss of appetite
2. Cardiovascular:
   • Bradycardia (slow heart rate)
   • 1° AV Block
   • Risk of syncope (fainting)
3. Neurological:
   • Insomnia
   • Dizziness
   • Headaches
4. Other:
   • Muscle cramps
   • Fatigue
   • Vivid Dreams
   • Exaggeration of pre-existing urinary dysfunction (bladder symptoms)

Caution: pre-existing CVD (blocks or arrhythmias)

• AV Blocks ECG
• Taking CCB or Beta Blocker (”-prolol”) may add to the problem