# Alzheimer's Disease - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Alzheimer Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499922/ · Donepezil Hydrochloride 5 mg Film-coated tablets SmPC section 4.2 Posology (eMC product 4428) · Ebixa 10 mg film-coated tablets SmPC section 4.2 Posology (eMC product 8222) · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PD01.00 - condition scope only, no dose - Verified date: 2026-09 ## Verified against - Donepezil Hydrochloride 5 mg Film-coated tablets SmPC section 4.2 Posology (eMC product 4428) - Ebixa 10 mg film-coated tablets SmPC section 4.2 Posology (eMC product 8222) - Alzheimer Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499922/ ## Treatment metadata - Donepezil — 5 mg — oral.solid - Memantine — 10 mg — oral.solid - Recognition, reversible-cause work-up and referral (Referral & Advice) ## Complete treatment card ```text ALZHEIMER'S DISEASE Sources: Alzheimer Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499922/ · Donepezil Hydrochloride 5 mg Film-coated tablets SmPC section 4.2 Posology (eMC product 4428) · Ebixa 10 mg film-coated tablets SmPC section 4.2 Posology (eMC product 8222) · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PD01.00 - condition scope only, no dose Review status: REVIEWED against 3 sources listed above (2026-09) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - Memory loss is the most common first symptom of Alzheimer disease [memory loss] - In early-onset disease diagnosed before 60, roughly a quarter first present with impaired judgment and visuospatial difficulty rather than memory loss - Trouble managing finances, shopping, meal preparation, or housekeeping reflects declining instrumental daily function - Caregivers often describe a gradual shift in memory, thinking, behavior, or daily function - One atypical variant brings progressive visual difficulty with problems in object and space perception, calculation, and reading, while memory stays relatively intact early on - Another variant starts with worsening language difficulty while memory is preserved early on - A less common variant shows impaired planning and executive function out of proportion to memory loss [memory loss] - In advanced disease the patient can stop talking and stop responding to being spoken to, eventually becoming bed-bound SIGNS - what you find (3) - The neurological exam is usually normal apart from loss of smell [loss of smell] - Unlike Alzheimer disease, loss of smell is not typically seen in vascular cognitive impairment or depression [loss of smell] - Advanced disease can bring focal findings such as apraxia, aphasia, frontal release signs, and primitive reflexes [slurred speech] TESTS (12) - Bedside screening with the MMSE, or preferably the MOCA, is part of the standard cognitive workup - The MOCA outperforms the MMSE for picking up mild cognitive impairment - The Mini-Cog, combining a clock-drawing task with three-item recall, is another primary-care screening test - Mini-Cog scores are not meaningfully skewed by a patient's education level - Basic bloodwork such as CBC, metabolic panel, TSH, and B12 is drawn to exclude other reversible causes, not because it shows AD-specific changes - A brain CT can show cerebral atrophy and third-ventricle widening, but these findings are nonspecific - MRI can show entorhinal cortex atrophy followed by medial temporal or hippocampal atrophy - Volumetric MRI can show hippocampal shrinkage, a characteristic feature linked to memory decline - EEG is usually normal in AD and is not a useful diagnostic tool, though it may show generalized slowing - FDG-PET can reveal metabolic impairment in the hippocampi in early or preclinical disease - CSF testing shows a drop in amyloid-beta 42 alongside a rise in phosphorylated and total tau - Genetic testing is not part of routine workup but is considered for families with rare early- onset disease IF NOT THIS - what else fits (10) - Depression-related pseudodementia needs to be excluded - Dementia with Lewy bodies is a key differential; watch for fluctuating cognition, visual hallucinations, and parkinsonism - Vascular dementia belongs on the differential list - Frontotemporal dementia mimics AD but visuospatial skills tend to stay intact, a useful discriminator - Dialysis dementia, a neurologic complication of chronic dialysis treatment, is another consideration - Vitamin B12 deficiency is a reversible cause that should be ruled out - Thyroid dysfunction can mimic cognitive decline and needs excluding - Polypharmacy is weighed as a possible contributing or mimicking factor - Alcohol or drug misuse is considered among the mimicking causes - Normal age-related memory change is distinguished from true dementia Source StatPearls "Alzheimer Disease" - disease-level clinical article Status traced to the source above Rx: Cognition - mild dementia | Cognition - moderate to severe disease | Recognition and referral COGNITION - MILD DEMENTIA 1. DONEPEZIL [1st line] Adult 5 mg once daily in the evening, held at 5 mg for at least one month; then 10 mg once daily if further benefit is wanted. Maximum 10 mg daily - long-term, benefit reassessed on a regular basis Peds Adult-only condition - paediatric section not applicable Choice Alternatives. Rivastigmine and galantamine are the other approved cholinesterase inhibitors; StatPearls calls donepezil the medication of choice and it is the simplest to take, one tablet a day. Memantine below is not an alternative to it - it is approved for moderate to severe disease and may be added to a cholinesterase inhibitor. Source Donepezil Hydrochloride 5 mg Film-coated tablets SmPC section 4.2 Posology (eMC product 4428); place in therapy from Alzheimer Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499922/ Why Acetylcholinesterase inhibitor. StatPearls names donepezil the medication of choice among the cholinesterase inhibitors, used in Alzheimer's disease with mild dementia, given once daily in the evening. The SmPC sets the amounts: start at 5 mg/day, hold that for at least a month so the earliest response can be judged and steady state reached, then 10 mg/day, which is the maximum recommended daily dose - doses above 10 mg/day have not been studied. Caution Diagnosis and the first prescription belong to the specialist service. The SmPC states treatment should be initiated and supervised by a physician experienced in diagnosing and treating Alzheimer's dementia, and started only if a caregiver is available who will regularly monitor that the patient takes it. Cholinesterase inhibitors are vagotonic and can slow the heart. The SmPC singles out sick sinus syndrome and other supraventricular conduction problems such as sinoatrial or atrioventricular block, and records syncope and seizures; in such a patient consider heart block or long sinus pauses. Post-marketing reports of QTc prolongation and Torsade de Pointes. Take care with a personal or family history of QTc prolongation, other QT-affecting drugs, uncompensated heart failure, recent myocardial infarction, bradyarrhythmia, or low potassium or magnesium. ECG monitoring may be needed. Nausea, vomiting and diarrhoea are the common effects. Peptic ulcer risk rises with a history of ulcer or concurrent NSAIDs. If it causes abnormal dreams, nightmares or insomnia, the SmPC allows moving the dose to the morning. Egypt ALKAPEZIL 5 MG 10 F.C. TABS. CHEMIPHARM 25.80 EGP (2.58/unit) ALZEPIZIL 5MG 14 F.C. TAB. GLOBAL NAPI P... 62.00 EGP (4.43/unit) DONAZIL 5 MG 30 F.C.TAB. EVA PHARMA 144.00 EGP (4.80/unit) ALZIMER 5MG 10 F.C. TAB. AMOUN 76.00 EGP (7.60/unit) DONEPEZIL 5MG 14 F.C. TAB. DELTA PHARMA 168.00 EGP (12.00/unit) ARICEPT 5 MG 14 TAB. PFIZER 392.00 EGP (28.00/unit) DONAZIL 5 MG 20 ODT TAB. EVA PHARMA 88.00 EGP LIDEMTZIL 5MG 30 ORALLY DISP. TABS. EGPI > LIFE 282.00 EGP COGNITION - MODERATE TO SEVERE DISEASE 2. MEMANTINE [2nd line] Adult Titrate 5 mg per week: 5 mg once daily in week 1, 10 mg in week 2, 15 mg in week 3, then the maintenance dose of 20 mg once daily from week 4. Maximum 20 mg daily. Patients over 65 take the same 20 mg daily - long-term; reassess tolerance and dose within three months of starting, and regularly after that Peds Adult-only condition - paediatric section not applicable Source Ebixa 10 mg film-coated tablets SmPC section 4.2 Posology (eMC product 8222); place in therapy from Alzheimer Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499922/ Why Partial NMDA antagonist; it blocks NMDA receptors and slows intracellular calcium accumulation. StatPearls records it as approved for moderate to severe Alzheimer's disease, and says it can be combined with a cholinesterase inhibitor such as donepezil. The SmPC sets the amounts: a maximum of 20 mg a day, reached by upward titration of 5 mg a week over the first three weeks to reduce undesirable effects. Caution Diagnosis and the first prescription belong to the specialist service. The SmPC states treatment should be initiated and supervised by a physician experienced in diagnosing and treating Alzheimer's dementia, and started only if a caregiver is available who will regularly monitor that the patient takes it. Caution in epilepsy, in a past history of convulsions, and where anything predisposes to seizures. Avoid other NMDA antagonists alongside it - amantadine, ketamine and dextromethorphan act at the same receptor, so central nervous system effects may be more frequent or more pronounced. Renal impairment changes the dose. No change is needed for creatinine clearance 50-80 ml/min; at 30-49 ml/min give 10 mg a day, raising to 20 mg only after at least 7 days if it is well tolerated; at 5-29 ml/min give 10 mg a day. Not recommended in severe hepatic impairment - the SmPC has no data there. No dose change in Child-Pugh A or B. Egypt DEMENTEXA 10MG 14 F.C.TAB. PHAROPHARMA 27.00 EGP (1.93/unit) CONDOMANIA 10 MG 30 F.C.TAB SIGMA > RAMEDA 60.00 EGP (2.00/unit) PENTABIXA 10 MG 30 F.C. TABS. PENTA PHARMA-... 66.00 EGP (2.20/unit) ALZIXA 10 MG 30 F.C. TABS. MASH PREMIERE 180.00 EGP (6.00/unit) MANTINE 10MG 30 F.C. TAB. ADWIA 180.00 EGP (6.00/unit) RAVEMANTINE 10MG 30 F.C. TABS. EVA PHARMA 180.00 EGP (6.00/unit) EBIXA 10MG 28 F.C. TAB. LUNDBECK > MU... 475.00 EGP (16.96/unit) MEMANTCARE 10 MG 20 SCORED F.C. TABS. MISR > PHARMACARE 62.00 EGP ZALHINAPEX 2MG/ML SYRUP 100 ML MULTI-APEX 33.00 EGP -> ? strength differs, ? different route - not oral solid MEMEXA 10MG/ML ORAL DROPS 15 ML DELTA PHARMA ... 51.00 EGP -> ? strength differs, ? different route - not oral solid RECOGNITION AND REFERRAL 3. RECOGNITION, REVERSIBLE-CAUSE WORK-UP AND REFERRAL (REFERRAL & ADVICE)[3rd line] Adult The most common cause of dementia, with insidious memory loss and progressive cognitive decline; a GP recognises the pattern, arranges basic work-up to exclude reversible causes, and refers to neurology/psychiatry for formal diagnosis and initiation of a cholinesterase inhibitor or memantine, continuing prescriptions once established. - Refer, with advice Peds Adult-only condition - paediatric section not applicable Source No dose - a recognition and referral pathway, not a medicine Why The most common cause of dementia, with insidious memory loss and progressive cognitive decline; a GP recognises the pattern, arranges basic work-up to exclude reversible causes, and refers to neurology/psychiatry for formal diagnosis and initiation of a cholinesterase inhibitor or memantine, continuing prescriptions once established. Caution The drugs above are started by the service the patient is referred to, not in primary care. They are listed so that the GP who continues the prescription knows the amounts, the titration and what to watch for. RED FLAG - Rapid (weeks to months) cognitive decline is atypical for Alzheimer's and needs urgent work-up for another cause. Refer also for new focal neurological signs, or depression that mimics or coexists with dementia. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)