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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE publish dementia guidance

The National Institute of Health and Clinical Excellence (NICE) and Social Care Institute for Excellence (SCIE) jointly published a Clinical Guideline containing recommendations on the treatment and care of people with dementia in health and social care.

At the same time NICE published the widely expected appraisal on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease.

The BBC has reported on the publication highlighting the controversy surrounding these guidelines and the expected legal challenge.

The appraisal of the drugs available for Alzheimer's disease recommends:

Donepezil, galantamine and rivastigmine can be prescribed for moderate Alzheimer's disease only, and if:

  • treatment is started by a doctor who specialises in the care of people with dementia
  • patients who are started on the drug are checked every 6 months, usually by a specialist team
  • the check-up includes a test called the Mini Mental State Examination (MMSE) and assessment of the patient's behaviour and ability to cope with daily life
  • the views of carers on the patient's condition are discussed at the start of drug treatment and at check-ups
  • the drug is stopped if the patient's MMSE score falls below 10 points, or if the drug isn't working
  • the least expensive of these three drugs is prescribed first. However, if this is not suitable for the patient another drug could be chosen

Memantine should not be prescribed for people with moderately severe to severe Alzheimer's disease unless it is being used as part of a clinical trial (research).

Patients already being treated with one of the three drugs recommended in the appraisal should be allowed to continue until the patient, carer and/or specialist decide it is the right time to stop.

Action: Clinicians should be aware of these new recommendations as they are getting substantial media coverage. Audits should be conducted to ensure specialist input is continued and that all four drugs are being used as recommended.

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