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Table 2 Comparison of Features of Acetylcholinesterase Inhibitors (AChEIs)

From: Current pharmacologic options for patients with Alzheimer's disease

AChEI (Binding) Mechanism of Action Dosing Schedule Recommended Daily Dosage Range Half-life Comments
Tacrine (Non-competitive, reversible) Inhibition of AChE Inhibition of BuChE 4 times daily 120–160 mg/day (Initial dose 40 mg/day) 3–5 hours Used in the United States as a last-line agent due to its short half-life and high incidence of hepatotoxicity
Donepezil (Non-competitive reversible) Inhibition of AChE Once daily 5–10 mg/day (Initial dose 5 mg/day) 70 hours Well tolerated, with positive effects on cognition, global function, and ADL
Rivastigmine (Non-competitive, reversible) Inhibition of AChE Inhibition of BuChE Twice daily 6–12 mg/day (Initial dose 3 mg/day) 1.5 hours Well tolerated, with positive effects on cognition, global function, and ADL
Galantamine (Competitive, reversible) Inhibition of AChE Allosteric modulation of nicotinic acetylcholine receptors Twice daily 16–24 mg/day (Initial dose 8 mg/day) 7 hours Well tolerated, with positive effects on cognition, global function, ADL, behavior, and caregiver time
  1. AChE, acetylcholinesterase; BuChE, butyrylcholinesterase; ADL, activities of daily living.