Donepezil is the first line anticholinesterase inhibitor and is licensed for use in patients with Alzheimers disease. It is a green drug on the BNSSG formulary and can be initiated and prescribed in primary care.
Refer to the BNSSG Prescribing Donepezil Guidance and additional guidance on initiating and prescribing Donepezil in primary care.
Galanatmine and rivastigmine are alternatives but both are currently amber drugs on the BNSSG formulary and therefore should only be intiated by a specialist or GP with interest in dementia under the shared care rules.
Memantine is a NMDA receptor antagonist and is recommended by NICE as an option for managing Alzheimer’s disease for people with moderate Alzheimer’s disease who are intolerant of or have a contraindication to AChE inhibitors, or for people with severe Alzheimer’s disease. At present it is an amber drug on the BNSSG formulary and should be initiated by a specialist although can also be initiated by a GP with an interest in dementia.
Refer to the NICE Guidelines (webpage) for further information.