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Alzheimer's drugs cost a lot, but help just a little

Here's why none of them received a Best Buy recommendation

Published: December 2012

More than 5 million people in the U.S. have Alzheimer’s disease, an insidious disorder that gradually destroys the brain, robbing people who have the condition of the ability to remember, complete everyday tasks, and function on their own. Several drugs are approved to treat it, including donepezil (Aricept and generic) and memantine (Namenda). But they don’t work well for most people, according to a new report from Consumer Reports Best Buy Drugs. In fact, it concluded that none of the drugs could be recommended as a Best Buy.

The decision was based in part on a large-scale analysis by the federal Agency for Healthcare Research and Quality and published in April 2010. It found that the drugs didn’t delay the onset of Alzheimer’s or improve or maintain mental function. An earlier review by the American College of Physicians and the American Academy of Family Physicians, published in 2008, reached similar conclusions.

Besides not being very effective, Alzheimer’s medication can cause side effects. While most are relatively minor, such as nausea, vomiting, diarrhea, dizziness, muscle cramps, and tremors, they could be debilitating in older people with dementia who can’t communicate their discomfort. In rare cases, the drugs can cause a slowed heartbeat, gastrointestinal bleeding, and possibly even convulsions or seizures. They’re also expensive: An average monthly prescription can range from $177 to more than $400.

Is it Alzheimer’s?

In the early stages of Alzheimer’s, people often have difficulty making and storing new memories. For example, they might forget conversations that just happened. As the disease progresses, they might have trouble doing simple math, wander away from home, or become delusional. Eventually they lose the ability to communicate, bathe, eat, dress, or use the toilet.

If you or somebody you care for is showing signs of dementia, the first step is to get an accurate diagnosis, preferably at a center that specializes in Alzheimer’s disease or geriatric medicine. A doctor can run tests to help identify Alzheimer’s and rule out other problems that can cause similar symptoms, such as depression, stroke, a brain tumor, an underactive thyroid, a vitamin deficiency, or the use of certain drugs, such as sleeping pills or tranquilizers.

Drugs to treat Alzheimer's disease

Generic name and strength¹	Brand name	Frequency of use per day²	Average monthly cost³
Donepezil tablet, 10 mg	Aricept	Once	$367
Donepezil tablet, 10 mg	Generic	Once	185
Galantamine tablet, 8 mg	Generic	Twice	183
Memantine tablet, 5 mg	Namenda	Twice	288
Rivastigmine capsule, 6 mg	Exelon	Twice	314⁴
Rivastigmine capsule, 6 mg	Generic	Twice	215
Rivastigmine patch, 4.6 mg/24 hr	Exelon	Once	360

1. Not all drugs or strengths are listed. For a more complete list, see our CR Best Buy Drugs Report on Alzheimer’s medication.

2. Frequency of use reflects typical dosing; some products can be used more or less frequently.

3. Prices reflect nationwide retail average for July 2012, rounded to the nearest dollar. Information is derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Pharma Solutions, which is not involved in our analysis or recommendations.

4. Due to low prescription volume, average price is calculated from last 12 months of data.

Options to try

While the progression of Alzheimer’s disease can’t be halted, there are strategies that can help ease some of the symptoms. Try nondrug options first, such as avoiding unfamiliar settings, eliminating situations that might cause embarrassment, and ensuring that other problems, such as constipation, infections, or side effects from medication, are addressed.

If those steps aren’t adequate and the person is exhibiting behavioral problems such as anxiety or depression, a doctor might prescribe an anti-anxiety drug or antidepressant to control symptoms. But it’s generally best to avoid antipsychotic drugs, such as olanzapine (Zyprexa and generic), quetiapine (Seroquel and generic), and risperidone (Risperdal and generic), unless they’re absolutely necessary—for example, to quell severe agitation or hallucinations. All of the antipsychotics have been linked to an increased risk of death in seniors with dementia.

Understandably, many people will still want to try an Alzheimer’s drug. In that case, you could consider generic donepezil or generic galantamine. Both have a lower risk of side effects and are easier for most people to tolerate than the other drugs. And they cost less than the brand-name options.

But the drugs’ effectiveness will probably be marginal at best. And if the person doesn’t show signs of improvement within three months, it’s unlikely he or she ever will, so it’s best to stop taking the drug. To access the full report, go to CRBestBuyDrugs.org.

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).