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Alzheimer’s Drugs: Summary of Recommendations
The medications used to treat mental decline in people with Alzheimer's disease are not particularly effective. When compared to a placebo, most people who take one will not experience a meaningful benefit. And once taken, it is rare for a person to experience a notable delay in the worsening of their symptoms over time. (The medications do not treat Alzheimer's disease directly, only its symptoms.)

Yet, there is no way to predict who will get a benefit from one of the five drugs approved to treat Alzheimer's disease and who will not. So the decision to try an Alzheimer's medication should be based on whether any potential benefit is worth the cost, and the risk of side effects.

  • Cost. Averaging about $177 to more than $400 per month, the Alzheimer's disease drugs are costly and may not be worth it if a person takes many other medications for other health conditions. This is true even if insurance or Medicare coverage helps pay since out-of-pocket payments can still be quite steep.
  • Side effects. One of the Alzheimer's medications, tacrine (Cognex), poses a risk of liver damage, so it is now prescribed only rarely. The four other drugs can cause several side effects. Most are minor, such as nausea, vomiting, dizziness, loss of appetite, muscle cramps, tremor, and weight loss. But for some people, these adverse effects might persist or be intolerable. These medications can also pose more serious side effects in rare cases, such as a slow heart beat, heart block, gastrointestinal bleeding and ulcers, and possibly convulsions or seizures.
Because most people who take an Alzheimer's medication will not experience a useful benefit, together with the relatively high price tag and the risk of rare but important safety concerns, we are unable to choose any of these drugs as a Best Buy.

However, we realize that many people will want to try one of these medications if they, or somebody they care for is suffering from Alzheimer's disease. In that case, it makes sense to try one that has the lowest rate of side effects and is the least expensive since none of the medications has been shown to be more effective than the others.

In that case, generic donepezil or generic galantamine meet both criteria. Both have a lower risk of adverse effects and higher tolerability than the other medications, and since they are generic, their price is much less than the brand-name medications.

But if the person taking the drug does not show signs of improvement within three months, it is unlikely that they ever will, so the drug should then be stopped.

This report was updated in June 2012.
Cost Comparison for Alzheimer's Disease Drugs*
Recommendations: Alzheimer’s Drugs
Generic Name and Dose Brand Name Frequency of Use Per Day1 Average Monthly Cost2
Donepezil tablet 5 mg Aricept One $363
Donepezil tablet 5 mg Generic One $208
Donepezil tablet 10 mg Aricept One $352
Donepezil tablet 10 mg Generic One $203
Donepezil tablet 23 mg Aricept One $309
Donepezil dissolvable tablet 5 mg Generic One $240
Donepezil dissolvable tablet 10 mg Generic One $210
Galantamine tablet 4 mg Generic Two $196
Galantamine tablet 8 mg Generic Two $183
Galantamine tablet 12 mg Generic Two $180
Galantamine sustained release capsule 8 mg Generic One $177
Galantamine sustained release capsule 16 mg Generic One $179
Galantamine sustained release capsule 24 mg Generic One $183
Memantine tablet 5 mg Namenda Two $269
Memantine tablet 10 mg Namenda Two $266
Memantine oral solution 10 mg/5ml Namenda Two $489
Rivastigmine capsule 1.5 mg Generic Two $222
Rivastigmine capsule 3 mg Generic Two $224
Rivastigmine capsule 4.5 mg Generic Two $219
Rivastigmine capsule 6 mg Exelon Two $316
Rivastigmine capsule 6 mg Generic Two $230
Rivastigmine Path/disc 4.6 mg/24 hr Exelon 1 $332
Rivastigmine Path/disc 9.5 mg/24 hr Exelon 1 $330
Tacrine capsule 10 mg Cognex Four $TK
* Medications with less than 20 prescriptions per month not included because the count is so low that the average price is unreliable and pharmacies are unlikely to carry medications with such low demand.

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

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