Starting and stopping treatment

We suggest some helpful questions that you may wish to ask your doctor, plus we provide insight in to process of stopping medication.

Questions to ask the doctor when starting the drugs

It is important that someone who has been prescribed drugs understands what it does and how to take it.

It may be helpful for the person with dementia or their carer to write down the following questions, and any answers the doctor provides.    

• Why have I been prescribed this drug specifically?
• What are the potential benefits of taking this drug?
• How long will it be before I see a result?
• If I get side effects, should I stop taking the drug immediately?
• What will happen if I stop taking the drug suddenly?
• Can I drink alcohol while taking the drug?
• How might this drug affect other medical conditions?
• What changes in health should I report immediately?
• How often will I need to visit the clinic or surgery?
• If this drug doesn’t suit me, can I try another drug?

Stopping treatment

Medication should be reviewed regularly, and continued for as long as the benefits outweigh any side effects.

Making the decision to stop medication

If the person with Alzheimer’s decides to stop taking a drug, they should speak to the doctor first if possible, or as soon as they can after stopping treatment.

Treatment may also be stopped by agreement with the doctor if the person becomes unable to take the medicines in the prescribed way, even with support.

Stopping and restarting

If someone stops taking their prescribed drug, their condition may get worse more quickly. If someone has stopped and thinks they should restart their medication, it is important that they contact their doctor as soon as possible.

Cholinesterase inhibitors

For someone who is taking a cholinesterase inhibitor, a decision will need to be made when their Alzheimer’s disease becomes severe.

There is now good evidence that cholinesterase inhibitors continue to bring benefits even when someone’s Alzheimer’s is severe. Many doctors therefore continue to prescribe a cholinesterase inhibitor for severe Alzheimer’s until the above criteria for stopping treatment are met, if ever.

The issue of whether to add memantine to the cholinesterase inhibitor for someone with severe Alzheimer’s disease (known as combination treatment) is less clear cut.

The two drugs work in different ways and there is research evidence that, for someone who is already on donepezil, adding memantine might bring additional benefit.

However, NICE guidance (2011) does not recommend combination treatment.