Acetylcholinesterase inhibitor
Reversibly inhibits acetylcholinesterase, increasing acetylcholine levels and enhancing cholinergic neurotransmission; also modulates nicotinic receptors which may improve cognitive function
Mild to moderate Alzheimer’s disease (AD)
Vascular dementia, mild cognitive impairment (MCI), dementia with Lewy bodies (DLB), post-stroke apathy
Immediate-release tablets, extended-release capsules, oral solution
Start 4–8 mg/day orally, titrate every 4 weeks as tolerated
8–24 mg/day in divided doses or once-daily extended release
Half-life approximately 7 hours; metabolized primarily via CYP2D6 and CYP3A4
Nausea, vomiting, diarrhea, weight loss, dizziness
Rare cardiac conduction abnormalities and syncope
Monitor for gastrointestinal symptoms, weight changes, and cardiac effects
None
May improve attention and executive function in vascular cognitive impairment and early AD. Use cautiously in patients with cardiac conduction abnormalities or history of syncope. Titrate slowly in elderly patients to minimize gastrointestinal and vagal side effects.