What is the most prescribed drug for dementia?

October 11, 2025 •

4 min read

According to recent healthcare data, donepezil (Aricept) is consistently one of the most prescribed medications for dementia, particularly for individuals diagnosed with Alzheimer's disease. While there is no cure for dementia, this and other drugs are used to help manage cognitive and behavioral symptoms, providing patients and caregivers with a better quality of life for a limited time.

Quick Summary

The most prescribed drug for dementia, specifically Alzheimer's, is often donepezil (Aricept), a cholinesterase inhibitor that improves communication between nerve cells. The article examines how this and other dementia medications work, comparing their mechanisms, uses, and potential side effects to offer a comprehensive overview of treatment options.

Key Points

Donepezil is the most prescribed drug for dementia caused by Alzheimer's. As a cholinesterase inhibitor, it treats mild, moderate, and severe forms of the disease.
Donepezil works by increasing acetylcholine levels in the brain, a neurotransmitter crucial for memory and learning.
Other major dementia medications include rivastigmine (Exelon) and galantamine (Razadyne), which are also cholinesterase inhibitors.
Memantine (Namenda) is another key drug that works differently by regulating glutamate and is typically used for moderate-to-severe Alzheimer's.
Drug choices often depend on the specific type and stage of dementia, as well as how a patient tolerates a medication.
Newer therapies, like lecanemab, target the underlying disease process but are not yet as widely prescribed as traditional symptomatic treatments.
Behavioral symptoms can be treated with other medications, such as antipsychotics or antidepressants, especially when non-drug strategies are insufficient.

The Most Commonly Prescribed Drug: Donepezil (Aricept)

Donepezil, marketed under the brand name Aricept, is widely considered the most frequently prescribed medication for managing symptoms of Alzheimer's disease, the most common cause of dementia. This cholinesterase inhibitor is approved to treat mild, moderate, and severe stages of Alzheimer's-related dementia. The widespread use of donepezil can be attributed to several factors, including extensive clinical experience with the drug, a relatively predictable side-effect profile, and its effectiveness in temporarily improving or stabilizing cognitive function.

Donepezil works by preventing the breakdown of acetylcholine, a vital chemical messenger in the brain responsible for nerve cell communication. In patients with Alzheimer's, acetylcholine levels are often depleted. By inhibiting the enzyme that destroys this neurotransmitter, donepezil helps boost its availability, thereby supporting communication between nerve cells involved in memory and learning. It is typically taken as a once-daily tablet, but a weekly transdermal patch version (Adlarity) is also available for those who have difficulty swallowing pills.

How Different Dementia Medications Work

The pharmacological landscape for dementia includes several classes of drugs, each with a distinct mechanism of action. The main medications approved to treat the cognitive symptoms associated with Alzheimer's disease fall into two primary categories: cholinesterase inhibitors and NMDA receptor antagonists.

Cholinesterase Inhibitors

This class of drugs works by preserving the brain's supply of acetylcholine. Besides donepezil, other examples include rivastigmine (Exelon) and galantamine (Razadyne). All three aim to improve communication between nerve cells, helping with memory, thinking, and other cognitive processes. While they work similarly, an individual's response, including side effects, can vary, and a doctor may switch a patient from one to another to find the best fit.

NMDA Receptor Antagonists

Memantine (Namenda) is the most common medication in this class, approved for use in moderate-to-severe Alzheimer's disease. It works differently than cholinesterase inhibitors by regulating glutamate, another chemical messenger in the brain. Excessive glutamate can overstimulate and damage brain cells. Memantine helps to protect nerve cells by blocking the toxic effects of this overstimulation, thereby slowing the progression of cognitive and functional decline.

Other Common Dementia Medications

In addition to the core cognitive-enhancing drugs, other medications may be prescribed to address the non-cognitive, behavioral, and psychological symptoms that often accompany dementia. These may include:

Antipsychotics: Prescribed cautiously and for short-term use, these may be used for managing severe agitation, aggression, hallucinations, or paranoia, particularly when non-drug strategies fail. Brexpiprazole (Rexulti) is one FDA-approved antipsychotic for agitation associated with Alzheimer's dementia.
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) may be used to treat depression or anxiety, which can worsen behavioral symptoms.
Sleep Medications: Insomnia is a common issue for people with dementia. Drugs like suvorexant (Belsomra) have been studied for this use.

Comparison of Common Dementia Medications


Feature	Donepezil (Aricept)	Rivastigmine (Exelon)	Memantine (Namenda)
Drug Class	Cholinesterase Inhibitor	Cholinesterase Inhibitor	NMDA Receptor Antagonist
Mechanism	Increases acetylcholine by preventing its breakdown	Increases acetylcholine and butyrylcholine by preventing breakdown	Regulates glutamate activity to protect brain cells
Primary Use	Mild, moderate, and severe Alzheimer's	Mild to moderate Alzheimer's and Parkinson's disease dementia	Moderate to severe Alzheimer's
Formulations	Tablet, orally disintegrating tablet, transdermal patch	Capsule, transdermal patch	Tablet, oral solution
Common Side Effects	Nausea, vomiting, diarrhea, insomnia, muscle cramps	Nausea, vomiting, weight loss, dizziness	Dizziness, headache, confusion, constipation
Key Consideration	Often the first-line choice due to long track record	Alternative for those who cannot tolerate oral medications (patch)	Can be used alone or combined with a cholinesterase inhibitor

The Role of Newer Therapies

Recent years have seen the development of disease-modifying therapies, which differ from symptomatic treatments like donepezil. These new drugs, such as lecanemab (Leqembi), target the underlying disease process by aiming to reduce beta-amyloid plaques in the brain. These are typically prescribed for people in the early stages of Alzheimer's disease. While representing a significant step forward, their use is more specialized and they are not currently the most widely prescribed drugs, which remain symptomatic treatments.

Conclusion

While there is no single cure for dementia, donepezil remains a cornerstone of symptomatic management for Alzheimer's disease. As a cholinesterase inhibitor, it helps to improve or stabilize cognitive function, offering a valuable tool for physicians and patients alike. Its prevalence as a treatment option, however, does not diminish the importance of other medications, including memantine and newer anti-amyloid therapies. Ultimately, the choice of medication depends on the specific type and stage of dementia, a patient's response to the drug, and their individual health profile. A thorough consultation with a healthcare professional is essential for determining the most appropriate and effective treatment plan.

For more information on treating Alzheimer's and related dementias, visit the National Institute on Aging website.

Frequently Asked Questions

No, donepezil and other current dementia medications are not a cure. They are primarily symptomatic therapies that can help manage and stabilize cognitive and behavioral symptoms for a limited time.

Common side effects of donepezil include nausea, diarrhea, vomiting, muscle cramps, and insomnia. These are often transient and can decrease over time.

Cholinesterase inhibitors, like donepezil, prevent the breakdown of the brain chemical acetylcholine. By increasing its levels, they can temporarily boost nerve cell communication, which is vital for memory and thought processes.

Donepezil is a cholinesterase inhibitor that increases acetylcholine, while memantine is an NMDA receptor antagonist that regulates glutamate activity. They work through different mechanisms and are often used to treat different stages of Alzheimer's, though they can be prescribed together.

Donepezil is primarily used for Alzheimer's-related dementia. However, cholinesterase inhibitors may also be prescribed for other types of dementia, such as Lewy body dementia and vascular dementia.

A doctor might prescribe rivastigmine, especially the transdermal patch, if a patient cannot tolerate oral medications or experiences fewer side effects with it. The patch can improve ease of administration.

Yes, for moderate-to-severe Alzheimer's, doctors may prescribe a combination therapy of a cholinesterase inhibitor like donepezil and an NMDA receptor antagonist like memantine. A combination pill (Namzaric) is also available.