Cholinesterase inhibitors prevent the breakdown of a type of neurotransmitter called acetylcholine. Doctors may prescribe this medication for certain neurodegenerative diseases, such as Alzheimer’s disease.

Cholinesterase inhibitors may benefit nerve cell communication and symptoms that affect memory, learning, and other thought processes.

However, there is also a risk of toxicity and adverse side effects that caregivers and anyone taking these medications should be aware of.

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Cholinesterase inhibitors stop theTrusted Source breakdown of the neurotransmitter acetylcholine into choline and acetate. They also increase the amount and length of acetylcholine’s actions in a person’s peripheral and central nervous systems.

The peripheral nervous system refers to the network of nerves outside the spinal cord and brain. These nerves send sensory messages to the central nervous system and receive messages from the spinal cord and brain to move muscles throughout the body.

Acetylcholine plays a roleTrusted Source in various processes, including:

  • nerve cell communication
  • memory
  • learning
  • other thought processes and functions

Cholinesterase inhibitors help maintain acetylcholine levels and help prevent the above functions from worsening.

Cholinesterase inhibitors are availableTrusted Source as oral medications or injections into the muscles or veins. The form someone uses may depend on the type they need.

The most suitable type may also depend on the condition they have. For example, the Food and Drug Administration (FDA)Trusted Source has approved the following three types for treating Alzheimer’s disease:

People can speak with a healthcare professional about the most suitable types for their condition.

Alzheimer’s disease involves theTrusted Source destruction of cells that create acetylcholine and the reduction of sensory signals that travel to parts of the brain.

Cholinesterase inhibitors can help prevent this breakdown. This increases levels of this transmitter in people with Alzheimer’s disease and other neurodegenerative conditions.

They are currently the main class of medication for Alzheimer’s disease. Although they cannot cureTrusted Source the condition, they may help reduce some of its symptoms, including those affecting:

  • memory
  • learning
  • thought processes

A 2021 study compared 11,652 people with Alzheimer’s dementia undergoing cholinesterase inhibitor treatment within 3 months of their diagnosis to 5,826 individuals without treatment.

People with the treatment had a 27% lower risk of death. They also had higher scores in a Mini-Mental State Examination each year — a screening tool that examines brain functions such as memory and attention.

The authors associated galantamine with the lowest risk of death, severe dementia, and cognitive (thinking) decline.

People who take cholinesterase inhibitors may developTrusted Source a condition called a cholinergic crisis, also known as SLUDGE syndrome. SLUDGE is a mnemonic of the following symptoms:

People may also experience the following side effects when taking cholinesterase inhibitors:

Who should avoid cholinesterase inhibitors?

People with a slow heart rate or conditions that affect heart conduction, such as sick sinus syndrome, need to avoidTrusted Source cholinesterase inhibitors. These medications may increase the risk of fainting or falling.

Those on medication to lower blood pressure may also need to avoid cholinesterase inhibitors, as these could lead to severe low blood pressure.

Anyone with allergies to cholinesterase inhibitors needs to avoid taking them. These medications can also increase the risk of gastrointestinal bleeding, so people with gastric ulcers should not take them.

People with neurodegenerative conditions such as Alzheimer’s disease can speak with a healthcare professional about cholinesterase inhibitors as part of their treatment.

Although these medications cannot cureTrusted Source these conditions, they may help individuals manage symptoms that affect memory and thought processes.

People can also speak with their healthcare team if they experience side effects, particularly SLUDGE syndrome.

SLUDGE syndrome is the most commonTrusted Source form of cholinesterase inhibitor toxicity. Other signs of toxicity may include:

Toxicity may require immediate treatment with other medications or ventilation.

Can cholinesterase inhibitors help with vascular dementia?

According to a 2021 review, some evidence suggests that certain cholinesterase inhibitors may have a slightly beneficial effect on thinking in people with vascular dementia.

However, the authors conclude that the extent of the benefit is too small to be clinically significant and note that further research is necessary.

Can people use cholinesterase inhibitors with other medications?

Doctors may combine cholinesterase inhibitors with some other Alzheimer’s medications, such as memantine (Namenda), which slows the buildup of calcium in cells.

However, people taking cholinesterase inhibitors always need to consult their healthcare team before starting a new medication.

How do cholinesterase inhibitors differ from other Alzheimer’s treatments?

Cholinesterase inhibitors help increaseTrusted Source levels of the neurotransmitter acetylcholine to benefit various thinking processes and nerve cell communication.

Professionals also approve partial N-methyl D-aspartate (NMDA) antagonists to treat Alzheimer’s disease. These medications slow the buildup of calcium in a person’s cells.

What should caregivers know about cholinesterase inhibitors?

Cholinesterase inhibitors may increaseTrusted Source the risk of fainting or falling, especially in people with heart conduction disorders.

Caregivers may also need to look out for adverse side effects or signs of toxicity, including SLUDGE syndrome, which may require immediate treatment.

Healthcare professionals may prescribe cholinesterase inhibitors for people with Alzheimer’s disease or other neurodegenerative conditions.

These medications increase levels of the neurotransmitter acetylcholine, which may benefit memory, thought processes, and nerve cell communication.

People taking cholinesterase inhibitors should contact their healthcare team if they experience side effects, such as lightheadedness or stomach upset. Signs of toxicity, such as SLUDGE syndrome, may require immediate treatment.