How are Alzheimer's drugs administered? A guide to treatment delivery options

With more than 6 million Americans living with Alzheimer’s, effective medication management is a critical aspect of care.

Understanding how are Alzheimer's drugs administered? is essential for patients, families, and caregivers to ensure the correct and most beneficial treatment plan is followed.

Quick Summary

Alzheimer's medications are administered through several key methods, including traditional oral tablets or liquids, convenient transdermal patches, and regular intravenous (IV) infusions for newer therapies. Each method has distinct advantages and may be prescribed based on the patient's stage of the disease and individual needs, emphasizing the importance of a personalized approach.

Key Points

• Oral Medications: Many common Alzheimer's drugs are taken as daily pills or liquids, but this can become challenging with memory issues or difficulty swallowing [1].

• Transdermal Patches: Patches like Exelon deliver a steady, continuous dose of medication through the skin, which can improve adherence and reduce gastrointestinal side effects [1].

• Intravenous (IV) Infusions: Newer monoclonal antibody therapies, including Leqembi and Kisunla, are given via IV infusions every few weeks in a clinical setting [1].

• Caregiver Role: Caregivers are instrumental in ensuring proper administration, which may involve using pill organizers, setting routines, or monitoring for side effects [1].

• Diverse Methods: The best method of drug administration depends on the patient's specific condition, stage of the disease, and personal needs, requiring a personalized approach from the healthcare team [1].

Oral Administration: Pills and Liquids

Many common Alzheimer's medications, particularly those for managing symptoms, are taken orally as tablets, capsules, or liquids. Examples include cholinesterase inhibitors like donepezil (Aricept) and galantamine (Razadyne), which help with memory and thinking, and glutamate regulators like memantine (Namenda) for moderate to severe Alzheimer's [1]. A combination drug (Namzaric) is also available in an extended-release oral form [1].

Challenges with oral administration

As Alzheimer's progresses, memory problems can lead to missed doses, and difficulty swallowing or confusion can cause resistance [1]. Caregivers can use strategies like pill organizers, establishing routines, or, after consulting a pharmacist, crushing certain pills [1].

Transdermal Patches: A Convenient Alternative

Transdermal patches, such as the rivastigmine (Exelon) patch, deliver medication through the skin over 24 hours [1]. This method can lead to fewer gastrointestinal side effects compared to oral medications and may improve adherence [1]. It also provides consistent drug levels [1]. Caregivers need to apply a new patch daily to a clean, dry area and rotate sites to avoid skin irritation [1].

Intravenous (IV) Infusions: For Newer Therapies

Newer monoclonal antibody treatments, like lecanemab (Leqembi) and donanemab (Kisunla), designed to slow early-stage Alzheimer's progression, are given via IV infusion in a healthcare setting [1].

The IV infusion process

Infusions are typically administered every two or four weeks and last about an hour [1]. They require medical supervision to monitor for side effects, including potential brain swelling or bleeding (amyloid-related imaging abnormalities, or ARIA) [1]. This method requires regular visits to an infusion center or clinic [1].

Comparison of Administration Methods

Feature	Oral Medications	Transdermal Patches	Intravenous (IV) Infusions
Examples	Donepezil, Galantamine, Memantine [1]	Rivastigmine (Exelon) [1]	Lecanemab (Leqembi), Donanemab (Kisunla) [1]
Frequency	Once or twice daily [1]	Once daily [1]	Bi-weekly or monthly [1]
Delivery	Swallowed pill or liquid [1]	Absorbed through the skin [1]	Direct injection into the vein [1]
Primary Use	Symptom management [1]	Symptom management [1]	Slowing disease progression [1]
Caregiver Effort	Can be challenging with memory loss or refusal [1]	Simple, but requires remembering daily application [1]	Transportation and time commitment for clinic visits [1]
Key Benefit	Widely available, often first-line treatment [1]	Improved adherence, fewer GI side effects [1]	Targets underlying disease pathology [1]
Key Consideration	Potential for missed doses or swallowing issues [1]	Risk of skin irritation [1]	Requires regular clinic visits, higher risk of ARIA [1]

Caregiver and Patient Considerations

Selecting the right administration method is a shared decision based on the patient's stage of illness, swallowing ability, and side effect tolerance [1]. Caregivers play a crucial role in medication management [1].

Caregivers should:

1. Understand the medications, including dosage and side effects [1].
2. Establish a consistent routine [1].
3. Use memory aids like pillboxes [1].
4. Communicate with healthcare providers about any issues [1].
5. Store medications safely [1].

Consulting resources like the Alzheimer's Association Medications Guide is recommended for current information on treatments [1].

Conclusion

Alzheimer's drugs are administered through oral, transdermal, and IV methods [1]. Oral and patch methods primarily manage symptoms, while IV infusions target disease progression [1]. The best method is personalized and determined in consultation with a healthcare provider [1]. Effective administration, supported by caregivers, is key to optimizing treatment and quality of life [1].

Frequently Asked Questions

Can Alzheimer's medications be crushed?

Some Alzheimer's medications can be crushed and mixed with food like applesauce or yogurt to aid in swallowing, but this is only possible if the medication is not an extended-release formulation. You must consult a pharmacist or doctor before crushing any pill, as some can lose their effectiveness or become dangerous if altered [1].

How do you handle a missed dose of an Alzheimer's drug?

If a dose is missed, follow the specific instructions from the prescribing physician or pharmacist. Generally, you should not double the next dose. If it's close to the time for the next scheduled dose, it's often best to skip the missed one entirely. A routine is crucial to prevent missed doses in the first place [1].

What are the benefits of a transdermal patch over oral medication?

The key benefits include improved medication adherence, as it only needs to be changed once daily, and a reduction in gastrointestinal side effects like nausea and vomiting because the drug bypasses the digestive system. It also provides a consistent level of medication in the bloodstream [1].

Is an IV infusion a permanent treatment method?

For newer anti-amyloid therapies like Leqembi and Kisunla, the treatment duration is still being evaluated. Patients are typically treated for a specific period based on clinical trial data, but long-term monitoring and subsequent treatment plans are determined by the healthcare provider [1].

How do caregivers manage medication resistance in a patient with dementia?

Managing medication resistance involves creating a calm environment, breaking the process into simple steps, and offering choices. It may also involve consulting the doctor to see if a different formulation, like a liquid or patch, is possible. Patience and routine are vital [1].

Are there side effects specific to certain administration methods?

Yes. Oral medications can cause gastrointestinal issues. Transdermal patches can cause skin irritation or allergic reactions at the application site. IV infusions, especially for anti-amyloid drugs, carry a risk of amyloid-related imaging abnormalities (ARIA), which are changes in the brain that must be monitored [1].

Where are IV infusions for Alzheimer's administered?

IV infusions for Alzheimer's drugs are administered in a controlled medical setting, such as a hospital outpatient center, a dedicated infusion clinic, or a specialized clinic, where medical professionals can monitor the patient throughout the process [1].