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Dementia Prescribing

Checked: 23-01-2022 by Vicky Ryan Next Review: 23-01-2023

Overview

All GP Practices in BNSSG have signed up to the Dementia Enhanced Service. Each practice will therefore have a dementia lead who will have attended training. This training must be cascaded to all GPs to enable them to undertake a diagnosis of dementia and initiate medication in line with guidance. All GPs are considered specialists once they have received training in this way.

Refer to the Prescribing in Dementia slides prepared by Dr Shan Williams of the Bristol Dementia Wellbeing Service

Anticholinesterases

Donepezil, Galantamine and Rivastigmine are the first line anticholinesterase inhibitors and are licensed for use in patients with Alzheimers disease.

They are now Blue on the BNSSG formulary to reflect that in addition to being initiated by a specialist or GP with a specialist interest, these drugs can now also be initiated by GPs who have undertaken the additional ‘Prescribing in Dementia’ training. If GPs haven't had the training, for any reason, they should discuss with the dementia lead at the practice.

Information on initiation and side effects can be found in the prescribing slides above.

NMDA receptor antagonist

Memantine is a NMDA receptor antagonist and is recommended by NICE as an option for managing Alzheimer’s disease for people with moderate Alzheimer’s disease who are intolerant of or have a contraindication to AChE inhibitors, or for people with severe Alzheimer’s disease.

It is Blue on the BNSSG formulary to reflect that in addition to being initiated by a specialist or GP with a specialist interest, these drugs can now also be initiated by GPs who have undertaken the additional ‘Prescribing in Dementia’ training. If GPs haven't had the training, for any reason, they should discuss with the dementia lead at the practice

Information on initiation and side effects can be found in the prescribing slides above.

Review

Patients should be reviewed initially after 3 months and then every 6 months (minimum) while on dementia medication.

Assessing meaningful benefits in this variably progressive syndrome is complex and difficult. Decline should have slowed for now and the patient may have improved in mood or motivation and function sufficient to carry on prescribing. If not, and/or the patient is experiencing side effects try an alternative and/or Memantine.

Further information on evaluation of treatment response is provided in the prescribing slides above.

Medication to avoid prescribing in dementia for common physical health conditions

Please see the Medication to avoid prescribing in dementia for common physical health conditions suggesting more suitable alternatives for dementia patients. This document has been approved by BNSSG APMOC (Area Prescribing and Medicine Optimisation Committee)

Resources

NICE Guideline (NG97) Dementia: assessment, management and support for people living with dementia and their carers.

Prescribing in Dementia slides prepared by Dr Shan Williams of the Bristol Dementia Wellbeing Service

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.