Acetylcholinesterase and butyrylcholinesterase inhibitor
Reversibly inhibits acetylcholinesterase and butyrylcholinesterase, increasing acetylcholine levels and enhancing cholinergic neurotransmission in the brain
Mild to moderate Alzheimer’s disease (AD), Parkinson’s disease dementia (PDD)
Vascular dementia, post-stroke apathy, apathy in Parkinson’s disease (PD)
Oral capsules, oral solution, transdermal patch
Oral: start 1.5 mg p.o. twice daily, titrated gradually as tolerated. Patch: start 4.6 mg/24 hours daily, increase to 9.5 mg/24 hours after 4 weeks; maximum 13.3 mg/24 hours
Oral: 1.5–12 mg/day; Patch: 4.6–13.3 mg/24 hours
Half-life approximately 1.5 hours (oral), with longer duration via patch; metabolized by cholinesterases rather than CYP enzymes
Nausea, vomiting, diarrhea, dizziness, fatigue
Rare cases of bradycardia, syncope, and gastrointestinal bleeding
Monitor for gastrointestinal symptoms, weight loss, and cardiac effects especially in elderly or frail patients
None
May benefit cognitive and behavioral symptoms in vascular dementia and post-stroke cognitive impairment. Preferred in Parkinson’s disease dementia due to dual FDA approval and relatively better tolerability in patients with motor disorders.