Aricept (Donepezil) vs. Alternative Dementia Drugs: Pros, Cons & Costs

Quick Takeaways

• Aricept (donepezil) is the most prescribed acetylcholinesterase inhibitor for mild‑to‑moderate Alzheimer's disease.
• Rivastigmine, galantamine, and memantine are the main FDA‑approved alternatives, each with a distinct mechanism.
• Side‑effect profiles differ: GI upset dominates for the cholinesterase inhibitors, while memantine can cause dizziness.
• Cost varies widely in Australia - generic donepezil is cheapest, memantine remains the priciest.
• Choosing an alternative often hinges on tolerability, stage of disease, and insurance coverage.

When a doctor first mentions "Aricept" for an Alzheimer's diagnosis, patients and families start asking, "Is there a better option?" This article compares Aricept (Donepezil) a once‑daily acetylcholinesterase inhibitor approved for mild‑to‑moderate Alzheimer’s disease with the three most common alternatives on the Australian market. We'll break down how each drug works, typical dosing, side effects, and out‑of‑pocket costs as of October 2025. By the end, you’ll know which medication fits a given clinical picture and how to discuss it with your prescriber.

Why Compare Alzheimer’s Medications?

Alzheimer’s disease (AD) progresses at different speeds, and patients react uniquely to each drug class. A medication that slows cognitive decline for one person might cause intolerable nausea for another. Moreover, the Australian Pharmaceutical Benefits Scheme (PBS) subsidises some drugs but not others, creating cost gaps that affect adherence. A side‑by‑side comparison helps you weigh efficacy against safety and affordability, turning a vague prescription into an informed treatment plan.

Mechanisms at a Glance

Understanding how each drug interacts with brain chemistry clarifies why side‑effects differ.

• Acetylcholinesterase inhibitors block the enzyme acetylcholinesterase, raising levels of the neurotransmitter acetylcholine. Higher acetylcholine can modestly improve memory and cognition.
• NMDA receptor antagonists moderate glutamate activity to protect neurons from excitotoxic damage. Memantine belongs here and is usually added in later disease stages.

Aricept, rivastigmine, and galantamine share the first mechanism, while memantine uses the second.

Drug Profiles & Typical Dosing

Below are the four most-prescribed options, each introduced with a micro‑definition for easy reference.

Rivastigmine a carbamate acetylcholinesterase inhibitor available as oral capsules and transdermal patches is approved for mild‑to‑moderate AD and Parkinson’s disease dementia. Starting dose is 1.5 mg twice daily, titrated to 6 mg twice daily; the patch delivers 4.6 mg/24 h and is increased to 9.5 mg/24 h.

Galantamine a benzazepine‑type acetylcholinesterase inhibitor marketed in immediate‑release tablets and extended‑release (ER) capsules begins at 4 mg twice daily, reaching 8‑12 mg twice daily; the ER form starts at 8 mg daily, maxing at 24 mg daily.

Memantine an NMDA receptor antagonist indicated for moderate‑to‑severe Alzheimer’s disease starts at 5 mg once daily, ramping to 20 mg twice daily.

Side‑Effect Snapshot

Side‑effects drive many switches between drugs. Here’s a quick visual guide:

Notice that the transdermal rivastigmine patch often reduces GI upset compared with oral capsules, a useful option for patients who can’t tolerate eating‑related side‑effects.

Cost Considerations in Australia (2025)

Pricing influences adherence, especially for patients without private health cover. Below are average out‑of‑pocket costs after PBS subsidies, based on July 2025 data.

• Aricept (Donepezil) - generic: AU$30‑40 per month.
• Rivastigmine - oral capsules: AU$45‑55 per month; transdermal patch: AU$70‑80 per month.
• Galantamine - ER capsules: AU$60‑70 per month.
• Memantine - tablets: AU$90‑110 per month.

If cost is a barrier, clinicians often start with generic donepezil before trialling higher‑priced options.

When to Switch or Add an Alternative?

Doctors weigh several cues before changing a regimen:

1. Intolerable side‑effects: Persistent nausea on donepezil may prompt a switch to rivastigmine patch.
2. Disease progression: Once patients move from mild to moderate AD, memantine can be added to an existing acetylcholinesterase inhibitor.
3. Comorbid conditions: Parkinson’s disease dementia responds well to rivastigmine, which also improves motor symptoms.
4. Financial constraints: If a patient’s PBS schedule limits coverage, generic donepezil often remains the most affordable.
5. Drug interactions: Galantamine interacts with CYP2D6 inhibitors; clinicians may avoid it if the patient is on certain antidepressants.

Always discuss any change with a pharmacist or neurologist to avoid abrupt discontinuation, which can worsen confusion.

Decision Guide: Choosing the Right Medication

Use this quick matrix to match patient profiles with the most suitable drug.

These scenarios are not exhaustive, but they illustrate common decision points doctors face.

Key Takeaway Checklist

• Start with Aricept (Donepezil) for most new mild‑to‑moderate AD cases.
• Switch to rivastigmine patch if GI side‑effects dominate.
• Consider galantamine when dosing flexibility is needed.
• Add memantine at moderate‑to‑severe stages, especially if donepezil alone no longer provides benefit.
• Always factor PBS coverage and out‑of‑pocket cost into the plan.

Frequently Asked Questions

Choosing the right Alzheimer’s medication isn’t a one‑size‑fits‑all decision. By comparing mechanisms, side‑effects, dosing, and costs, you can partner with your doctor to find the balance that works for your loved one’s health and budget.