title: Clinically Relevant Drug Interactions with Anti-Alzheimer's Drugs.
abstract: BACKGROUND
  The aging world population had led to an increase in the prevalence of Alzheimer's disease (AD). The drugs used to slow down the onset of AD, galantamine, donepezil, rivastigmine and memantine, are generally well-tolerated. However, drug interactions between these drugs and other drugs are an important aspect of patient safety that should be borne in mind, particularly given the high burden of polypharmacy in the elderly. The aim of this review is to provide an updated review of clinically significant drug-drug interactions concerning drugs approved for AD.
  
  
  METHODS
  PubMed was searched for relevant keywords. No time limit was imposed but only articles in English published in peer-reviewed journals were selected. Relevant literature was also identified from the references of identified articles. Further information was obtained from drug summary of product characteristics.
  
  
  RESULTS
  The major pharmacokinetic interactions identified concerned fluoxetine, paroxetine and ketoconazole when used with galantamine or donepezil. On the other hand, the major potential pharmacodynamic interactions concerned anti-dementia drugs and general anesthesia agents, anti-cholinergic drugs, conventional antipsychotics and bradycardia-inducing drugs. In clinical practice memantine shows a lower potential for pharmacodynamic drug-drug interactions (DDIs) compared to other drug classes.
  
  
  CONCLUSIONS
  The concomitant use of anti-dementia drugs with other drugs can have variable clinical effects, making appropriate prescribing of these drugs very challenging. A simple and coherent way of presenting evidence on complex drug interaction information from heterogenous sources to clinicians is needed in order for the voluminous data available to have an impact on clinical practice.
authors.affiliation: Department of Drug Sciences, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Caraci
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: Janet
authors.initials: J
authors.lastname: Sultana
authors.affiliation: Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Drago
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Spina
mesh_terms: D000544:Alzheimer Disease / Q000188:drug therapy*; D000818:Animals; D004347:Drug Interactions; D006801:Humans; D018697:Nootropic Agents / Q000627:therapeutic use*
chemical_list: D018697:Nootropic Agents
keywords: Alzheimer's disease; cholinesterase inhibitors; drug interactions; memantine; pharmacodynamics; pharmacokinetics