Cholinesterase Inhibitors for Alzheimer's Disease

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Cholinesterase Inhibitors for Alzheimer's Disease


Generic NameBrand Name

How It Works

Acetylcholine is a neurotransmitter (a brain chemical) that helps with memory and thinking. Alzheimer's disease breaks down acetylcholine. And people who have Alzheimer's disease make less of this chemical over time. These two things result in the gradual loss of memory and thinking skills.

Medicines called cholinesterase inhibitors help stop acetylcholine from breaking down. They can help brain cells work better. But they don't stop or reverse the destruction of brain cells and loss of acetylcholine that occur in Alzheimer's disease. They don't prevent the disease from getting worse, but they may slow it down.

These medicines don't make acetylcholine, though. So over time they may stop working.

Why It Is Used

Cholinesterase inhibitors may be used to treat some symptoms of Alzheimer's disease. They also may be used in other types of dementia, such as dementia with Lewy bodies and multi-infarct dementia.

Experts agree that reducing problems with memory loss may help people with Alzheimer's disease live better. In some cases, reducing these problems may help people live more independently for a longer period of time.

How Well It Works

Cholinesterase inhibitors may produce small improvements in memory and general ability to function. For example, the person may be able to remember friends' names better and be able to dress himself or herself with less difficulty.

The various cholinesterase inhibitors have similar effects on memory and cognitive function. So the decision about what medicine to use may be based on side effects, dosing schedules and ease of use, individual response to a particular medicine, or other factors.

Cholinesterase inhibitors do not work for everyone who has Alzheimer's disease, but they are helpful for some people. They may be a reasonable option for those who understand the risks and costs and feel the possible benefits are worth it. As the disease progresses, the medicine eventually may stop working.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.

Common side effects of this medicine include:

  • Nausea.
  • Diarrhea.
  • Vomiting.
  • Indigestion.
  • Loss of appetite and weight loss.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Rivastigmine (Exelon) can be given through a skin patch. Skin patches release medicine into the blood at a steady level and may reduce side effects. And when a person uses a skin patch, it's easier for caregivers to be sure the person is getting his or her medicine properly.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.


Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.


ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerMyron F. Weiner, MD - Psychiatry, Neurology
Last RevisedOctober 29, 2012

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