Naslov
The cholinesterase inhibitors – current clinical view and Croatian reality

Autori
Mimica, Ninoslav

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
10th International Meeting on Cholinesterases / Kovarik, Zrinka - Zagreb : Hrvatsko Društvo za Biotehnologiju, 2009, 73-74

Skup
10th International Meeting on Cholinesterases

Mjesto i datum
Šibenik, Hrvatska, 20.09.2009. - 25.09.2009

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Cholinesterase inhibitors; Dementia; Treatment

Sažetak
For the treatment of dementia in persons with Alzheimer's disease (AD), at the moment, five drugs (tacrine ; donepezil ; rivastigmine ; galantamine and memantine) are approved by the United States Food and Drug Administration (FDA). Four of them are acetylcholinesterase inhibitors (AChEI), three of them are approved for the treatment of mild to moderate AD and one of them for treatment of all three stages of AD. Among above mentioned antidementives in Croatia, till now, only three i.e. donepezil (Aricept ; Aricept Evess ; Donepezil Pliva ; Yasnal), rivastigmine (Exelon Patch) and memantine (Ebixa) are registered, but not single one is on reimbursement list of Croatian Institute for Health Insurance. Thus, these drugs have relatively high cost which makes them almost unavailable to patients. Even though Croatian algorithm for psychopharmacological treatment of AD, done by Croatian association for clinical psychiatry, exists and suggests which antidementive drug should be given in particular stage of AD, these patients are more often prescribed alternative or adjuvant treatment only (i. e. ginkgo biloba ; nootropics ; statins ; nonsteroidal anti- inflammatory drugs ; omega-3 fatty acids ; vitamins ; NADH ; trace elements ; etc.). In general, antidementives are well tolerated and undesired effects are rare ; except hepatotoxicity of tacrine and gastrointestinal side effects of donepezil, rivastigmine, galantamin and tacrine that results from acetylcholinesterase inhibition. Nausea, diarrhea, vomiting, and weight loss are the most common side effects of the acethycholinesterase inhibitors. The side effects may be managed using slow titration and administration with food. All AChEl can be taken safely in combination with the glutamate receptor antagonist memantine. Patient on combination therapy memantine-donezepil has fewer side effects than those on donepezil alone, particularly gastrointestinal side effects. Today we record tremendous increase in prevalence of AD. Therefore, it is understandable that great effort and humongous amount of money is put in research, on a daily bases, of new treatment possibilities of this late-life disease. In the future we expect greater improvements in practical psychophramacological therapy of PWD, but till then, the AChEl will remain the standard treatment for PWD. So, we strongly advocate that antidementives, which are registered in Croatia, should be on reimbursement list.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA