Contraindications – When should a cholinesterase inhibitor not be given?
Cholinesterase inhibitors must not be given for different diseases on different organs, as otherwise the disease may worsen and sometimes life-threatening consequences may result. First of all, there are diseases of the heart where there is a disturbance of the electrical impulse conduction (AV-BLock) or a too low heart rate. In addition, cholinesterase inhibitors must not be given for diseases of the lungs that are associated with a narrowing of the bronchial tubes (for example bronchial asthma).
A further contraindication is an increased intraocular pressure. If glaucoma is present, in the worst case this can lead to loss of the eye. In addition, a cholinesterase inhibitor must not be taken during pregnancy or while breastfeeding. A further contraindication is a severe liver or kidney dysfunction.
Dosage
The recommended dosage for cholinesterase inhibitors differs depending on the active ingredient and on the indication. The treating physician will in any case try to select the most suitable preparation in the dosage suitable for the individual patient. – The cholinesterase inhibitors donezepil and galantamine, for example, which are approved for the treatment of Alzheimer’s dementia, are often administered as patches in which approx.
10mg of active substance is absorbed through the skin within 24 hours. – Neostigmine as a representative of the cholinesterase inhibitors that do not act in the brain, on the other hand, is administered in a single dose of 0.5 to 2mg via a vein into the blood. – Distigmine in the form of tablets contains 5mg of active ingredient and is usually taken once a day. However, a reduced dosage may be necessary if liver or kidney function is restricted.
Price
If a cholinesterase inhibitor is medically indicated, both statutory and private health insurance companies will cover the costs. For example, the price of the active ingredient distigmine is the equivalent of two euros per tablet. The other active ingredients are only slightly different in price. The cost of treating Alzheimer’s dementia with one of the cholinesterase inhibitors approved for this purpose is between 1,000 and 2,000 euros per year. The application in the form of capsules is generally cheaper than in the form of patches.
Cholinesterase inhibitor and alcohol – is that compatible?
As a general rule, caution should be exercised when taking medication and alcohol. There is no direct interaction with the cholinesterase inhibitor, but since alcohol can also have an effect on the signal transmission of nerve cells, consumption should be avoided. However, small amounts, such as a bottle of beer or a glass of wine in the evening, are of little concern. Larger quantities can have a strong influence on the effect.
Alternatives to a cholinesterase inhibitor
The alternatives to cholinesterase inhibitors depend on the disease or condition to be treated. In the therapy of Alzheimer’s dementia, for example, herbal products based on gingko extract are available. On the other hand, there is memantine as an alternative active substance which attacks another messenger system in the brain. For the treatment of glaucoma, preference is given to drugs which, unlike cholinesterase inhibitors, do not indirectly but directly amplify the mode of action of the acetycholine-mediated signal transmission, which leads to a reduction in intraocular pressure.
