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Cholinesterase inhibitors used for treatment of dementia: Dose and administration

Cholinesterase inhibitors used for treatment of dementia: Dose and administration
Drug Formulations Starting dose Maintenance dose Comments
Donepezil Tablet or oral disintegrating tablet 5 mg orally, once daily 10 mg daily (increased after 4 to 6 weeks)*  
Galantamine Immediate-release tablet or solution 4 mg orally, twice daily 12 mg twice daily (increased in monthly intervals by 4 mg twice-daily increments) Give with meals. Maximum 8 mg twice daily with moderate renal or liver impairment. Do not use with severe renal or liver impairment.
Extended-release capsule 8 mg orally, once daily 24 mg once daily (increased in monthly intervals by 8 mg once-daily increments) Maximum 12 mg once daily with moderate renal or liver impairment. Do not use with severe renal or liver impairment.
Rivastigmine Capsule 1.5 mg orally, twice daily 6 mg twice daily (increased in 2- to 4-week intervals by 1.5 mg twice-daily increments) Give with meals. Slow and cautious titration with renal or liver impairment or low body weight.
Transdermal patch 4.6 mg/24 hours 9.5 to 13.3 mg/24 hours (increased in monthly intervals by 4.6 mg increments) Can cause rash; rotate sites. Fewer side effects than capsule. Maximum dose 4.6 mg/24 hours with mild to moderate liver impairment or low body weight. Do not use with severe liver impairment.
*A 23 mg noncrushable tablet of donepezil is available, but evidence does not support a clinically important advantage to the higher dose and it is associated with increased side effects.
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