Antidementives (general)

Active substances and pharmaceuticals concernedSpecially affected active substances and pharmaceuticalsMechanism of interactionConsequences and possible symptoms of the interactionRecommended SupplementationSpecial instructions for useReferences

Active substances and pharmaceuticals concerned

Name of active substance	Trade name	Affected micronutrients
Donepezil	Aricept®	B-Vitamins Phosphatidylserine
Rivastagmine	Exelon®
Galantamine	Reminyl®
NMDA-antagonists	Axura®, Ebixa®

Specially affected active substances and pharmaceuticals

Name of active substance	Trade name	Affected micronutrients
Donepezil	Aricept® Demelan®	α-lipoic acid
Rivastigmine	Exelon®, Nimvastid®
Galantamine	Reminyl®

Mechanism of interaction

Mechanism of interaction
B vitamins	The metabolism of energy and neurotransmitter is significantly influenced by B vitamins
Phosphatidylserine (PS)	PS is the most dominant phospholipid in the brain, regulating the release and signal transduction of neurotransmitters. A lack of PS can lead to a decrease in NGF receptor density in the cerebellum and hippocampus as well as to a disturbance in cerebral glucose utilization. Oxidative nerve cell membrane damage, memory and concentration disorders and a tendency toward depression can occur.
α-lipoic acid	α-lipoic acid has a neuroprotective effect due to its antioxidant, anti-inflammatory and proenergetic effects. Both protein glycolysis and activation of the redox-sensitive transcription factor NFkappaB are inhibited.

Consequences and possible symptoms of the interaction

Positive consequences of the interaction		Possible symptoms
B vitamins	Improvement in effectiveness of antidementives	Stabilization of cognitive performance in mild dementia
Phosphatidylserine (PS)	Improvement in effectiveness of antidementives	Stabilization of cognitive performance in mild dementia
α-lipoic acid	Synergism with cholinesterase inhibitors	With mild to moderately severe dementia, cognitive abilities may stabilize or improve.

Recommended Supplementation

Medical substance	Recommended supplementation	Dosage
Cholinesterase inhibitors, NMDA antagonists	Vitamin B complex especially with folic acid and vitamin B₁₂
Cholinesterase inhibitors, NMDA antagonists	Phosphatidylserine (PS)	3x 100 mg/d p.o.
Cholinesterase inhibitors	α-lipoic acid	2 x 600 mg/d p.o. Additional 2-3 x/week 600 mg i.v.

Special instructions for use

Instructions for use
Phosphatidylserine (PS)	PS should always be given with a vitamin B complex supplement.
	Vitamin-B₁₂- ,vitamin-B₆- and folic acid supplementation in dementia patients should always be considered.

References

Elias MF et al. Homocysteine, folate, and vitamins B6 and B12 blood levels in relation to cognitive performance: the Maine-Syracuse study. Psychosom Med. 2006 Jul-Aug;68(4):547-54.
Holmquist L et al. Lipoic acid as a novel treatment for Alzheimer's disease and related dementias. Pharmacol Ther. 2007 Jan;113(1):154-64. Epub 2006 Sep 20.
Gröber U. Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Auflage, 2011
Gröber U. Arzneimittel und Mikronährstoffe. Medikationsorientierte Supplementierung. 3. Akt. und erw. Auflage, 2014
Elias MF et al. Homocysteine, folate, and vitamins B6 and B12 blood levels in relation to cognitive performance: the Maine-Syracuse study. Psychosom Med. 2006 Jul-Aug;68(4):547-54.
Riggs KM et al. Relations of vitamin B-12, vitamin B-6, folate, and homocysteine to cognitive performance in the Normative Aging Study. Am J Clin Nutr. 1996 Mar;63(3):306-14.
Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L.: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. 2008