Table 2.

(A) Food and Drug Administration-approved AD therapies and (B) medical foods

		Approved/intended indication	Administration
	Mechanism		Route	Dosing	Frequency
(A) Pharmacologic agents
Donepezil (Aricept®)49	ChEI	Mild-to-moderate AD Moderate-to-severe AD	PO (tablet)	Titration: Initiate 5 mg/day May increase to 10 mg/day after 4–6 weeks Severe AD: may increase to 23 mg/day after additional 3 months (minimum) Maintenance: Mild-to-moderate AD: 5 or 10 mg/day Moderate-to-severe AD: 10 or 23 mg/day	Once daily
Galantamine (Razadyne®)50	ChEI	Mild-to-moderate AD	PO (tablet/oral solution)	Titration: Initiate: 8 mg/day Increase to 16 mg/day after 4 weeks (minimum) May increase to 24 mg/day after additional 4 weeks (minimum) Maintenance: 16 or 24 mg/day	Twice daily, with food
Galantamine ER (Razadyne® ER)50	ChEI	Mild-to-moderate AD	PO (capsule)	Titration: Initiate: 8 mg/day Increase to 16 mg/day after 4 weeks (minimum) May increase to 24 mg/day after additional 4 weeks (minimum) Maintenance: 16 or 24 mg/day	Once daily, in morning, with food
Rivastigmine (Exelon®)51	ChEI	Mild-to-moderate AD Mild-to-moderate PDD	PO (capsules/oral solution)	Titration: Initiate: 3 mg/day If tolerated, may increase to 6 mg/day, and further to 9 and 12 mg/day after 2 weeks (minimum) at previous dose (4 weeks for PDD) Maintenance: Mild-to-moderate AD: 6–12 mg/day Mild-to-moderate PDD: 3–12 mg/day	Twice daily
Rivastigmine patch (Exelon® Patch)52	ChEI	Mild-to-moderate AD Severe AD Mild-to-moderate PDD	TD patch	Titration: Initiate: 4.6 mg/24 h After 4 weeks (minimum), if tolerated, increase to 9.5 mg/24 h May increase to 13.3 mg/24 h after additional 4 weeks (minimum) Maintenance: Mild-to-moderate AD: 9.5 or 13.3 mg/24 h Severe AD: 13.3 mg/24 h Mild-to-moderate PDD: 9.5 or 13.3 mg/24 h	Apply new patch once every 24 h
Memantine (Namenda®)66	NMDA receptor antagonist	Moderate-to-severe AD	PO (tablet/oral solution)	Titration: Initiate 5 mg/day Increase to 10 mg/day, and further to 15 and 20 mg/day after 1 week (minimum) at previous dose Maintenance: 20 mg/day	Twice daily
Memantine (Namenda®) XR67	NMDA receptor antagonist	Moderate-to-severe AD	PO (capsules)	Titration: Initiate: 7 mg/day Increase dose (14, 21, and 28 mg/day) after 1 week (minimum) on previous dose Maintenance: 28 mg/day	Once daily
(B) Medical foods
Caprylidene (Axona®)72	Medical food – nutritionally supports brain metabolism	Mild-to-moderate AD	PO (powder to be added to 4–8 oz of liquid)	Titration: 8–10 g/day for 2 days Increase dose by 8–10 g every other day, as tolerated, up to a maximum of 40 g/day Maintenance: 40 g/day	Once daily after food
l-methylfolate/methylcobalamin/N-acetylcysteine (CerefolinNAC®, Triveen-CF NAC®)73	Medical food – supports the brain's metabolic balance	Mild or moderate cognitive impairment	PO (caplet)	1 caplet/day	Once daily
Phosphatidylserine/docosahexaenoic acid/eicosapentaenoic acid (Vayacog®)	Medical food – supports management of lipid imbalances	Early memory impairment	PO (capsule)	1 capsule/day	Once daily
Omega-3 fatty acids, uridine, choline, vitamins C, E, B6, and B12, selenium, and folic acid (Souvenaid®)	Medical food – supports synaptic integrity	Early AD	PO (liquid)	1 bottle (125 mL) per day	Once daily

In contrast to FDA-approved drugs, no premarket review process exists for medical foods: data supporting their effectiveness (if such data exist) have not undergone the same rigorous scientific scrutiny as approved drugs. AD, Alzheimer's disease; ChEI, cholinesterase inhibitor; ER, extended release; NMDA, N-methyl-d-aspartate; PDD, Parkinson's disease dementia; PO, per os (oral administration); TD, transdermal.