Rationalising acetylcholinesterase inhibitors and memantine in palliative care
Follow the principles of medication rationalisation when rationalising acetylcholinesterase inhibitors or memantine in patients with palliative care needs.
The balance of benefits and harms of acetylcholinesterase inhibitors and memantine can change over time; deprescribe these drugs in patients who are no longer benefitting from therapy, or who have severe or advanced dementia1.
Make a plan for withdrawing acetylcholinesterase inhibitor or memantine therapy before patients become unable to swallow. It is preferable to avoid stopping acetylcholinesterase inhibitors and memantine abruptly to reduce the risk of rapid functional and cognitive decline, or severe behavioural or psychological symptoms. Instead, slowly reduce the dose as described in the Psychotropic guidelines. Monitor the patient for changes in cognition, function, behaviour and quality of life after each dose reduction.
For principles of palliative care for patients with dementia, see Principles of palliative care for patients with dementia.