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Patients Often Fail to Adhere to Alzheimer’s Drug Schedules

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Many people with Alzheimer’s disease who start taking drugs for the condition stop taking them regularly or don’t take the optimal dosage, a new study reports. Medication side effects and costs may be major reasons.

The study, in the Journal of the American Geriatrics Society, found that by 18 weeks of starting a new drug prescription, only about half of patients were still taking them.

The study looked at cholinesterase inhibitors, a class of drugs that are commonly prescribed for early Alzheimer’s. Drugs of this type include Aricept (generic name donepezil), Razadyne (galantamine) and Exelon (rivastigmine). While medications for Alzheimer’s may ease symptoms for a time, however, they do not stop the relentless downward progression of disease.

For the study, researchers from the Indiana University Center for Aging Research and the Regenstrief Institute in Indianapolis looked at 126 older patients at four memory clinics in the area. Their average age was 80. They had a variety of medical problems and were taking, on average, eight other medications in addition to one of these Alzheimer’s drugs.

The researchers found that under these “real-world conditions,” patients often stopped taking the drugs or didn’t take them regularly and therefore were often not reaching the optimal dosage. Over the 18-week course of the study, only 53 percent of those taking Aricept reached the desired target dose. Only 19 percent of those prescribed Exelon and a mere 5 percent of those prescribed Razadyne reached the dose needed for maximum effect.

“While these medications do not change the course of the disease, by not getting patients to target doses, we aren’t optimizing the potential benefits these medications may provide,” said Noll Campbell, the study leader.”Having a better understanding of those to whom the drugs are targeted may provide us with greater insight into how to increase benefits and reduce risk.”

Over half of all the participants stopped taking a drug because of a bothersome side effect. Common side effects included bone and muscle pain,muscle cramps, dizziness, headaches and nightmares. Digestive side effects like vomiting, nausea and diarrhea were also common.

Side effects primarily arose when patients started taking the drug or early in the course of treatment. Some may have been the result of interactions with other medications the patients were taking.

Cost was also a reason why some patients stopped taking the drugs. About one in seven of those taking Exelon or Razadyne said they stopped taking it because it was too expensive. Those taking Aricept were less likely to complain about costs; it tends to be cheaper than the other drugs.

“Physicians should be aware of the impact of side effects, many of which are shared with other medications that the patient is taking, on both the adherence to the medication and quality of life,” said Dr. Campbell, who is on the faculty of the Purdue University College of Pharmacy. “While these drugs aren’t the answer to Alzheimer’s disease, improving tolerability and adherence may reduce the complications of the disease.”

By www.ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.

Source: Noll Campbell, PharmD; et al: “Adherence and Tolerability of Alzheimer’s Disease Medications: A Pragmatic Randomized Trial.” Journal of the American Geriatrics Society, April 2017.

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