The “Antidementia Drugs” are not discussed in the chapter “Psychotropic Drugs” of the Drug Prescription Report 2012 (see my posts from November 9th, 2012, from December 16th, 2012 and from January 19th, 2013), but in a separate chapter. This chapter was not written by Martin Lohse and Bruno Müller-Oerlinghausen but Ulrich Schwabe, one of the two editors of the Drug Prescription Report. Different from the chapter “Psychotropic Drugs”, the chapter on “Antidementia Drugs” is written objectively and scientifically throughout.
Prescription of antidementia drugs has changed considerably in the last decade in Germany.
While in 2002 the vast majority of prescriptions contained piracetam and ginkgo preparations, the proportion of prescriptions of acetylcholinesterase inhibitors (AChEI) and memantine in the total group of antidementia drugs was 77% in 2011. Prescription of the AChEI donepezil, galantamine and rivastigmine and the NMDA antagonist memantine has been increasing continuously for ten years.
The following amounts were prescribed in 2011 (followed by the DDD net cost in €):
Acetylcholinesterase-Inhibitors total: 52.8 Mio. DDD (€ 3.77)
- Donepezil (Aricept) 26.8 Mio. DDD (€ 3.48)
- Galantamine (Reminyl) 13.0 Mio. DDD (€ 3.80)
- Galantamine (Galnora) 1.2 Mio. DDD (€ 3.10)
- Rivastigmine (Exelon) 11.8 Mio. DDD (€ 4.46)
Memantine 28.0 Mio. DDD (€ 3.33)
Piracetam 14.3 Mio. DDD (€ 0.38)
Ginkgo biloba 5.5 Mio. DDD (€ 1.05)
Nicergoline 1.4 Mio. DDD (€ 0.51)
While the efficacy of piracetam, ginkgo biloba and nicergoline in dementia of the Alzheimer’s type is not consistently documented, AChEI and memantine have a clearly documented efficacy on cognitive function and activities of daily living. This has been shown by dozens of clinical trials, and several Cochrane reviews also come to this conclusion. However, they are still being prescribed in relatively modest scale, which is probably due to the fact that the clinical benefit of these drugs is still discussed controversially. This is probably because the effect in individual patients – due to the nature of the disease – is not seen as so pervasive, such as with antidepressants or antipsychotics. Nevertheless, there is a clear tendency for change. If the regulation of the two classes of compounds is now at 81 million DDD, it was in 2002, yet only 29 million DDD.
This post is also available in: German