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Cited by 368Cholinesterase and Neurodegenerative DiseasesAlzheimer's disease research and treatmentsPharmacogenetics and Drug Metabolism

The DOI matches its Crossref record; 101 of the 105 references it cites were found in a registry or an index.

Clinical Pharmacokinetics and Pharmacodynamics of Cholinesterase Inhibitors

Jann, Michael W., Shirley, Kara L., Small, Gary W.·2002·Clinical Pharmacokinetics
DOI 10.2165/00003088-200241100-00003
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Abstract

Cholinesterase inhibitors are the 'first-line' agents in the treatment of Alzheimer's disease. This article presents the latest information on their pharmacokinetic properties and pharmacodynamic activity. Tacrine was the first cholinesterase inhibitor approved by regulatory agencies, followed by donepezil, rivastigmine and recently galantamine. With the exception of low doses of tacrine, the cholinesterase inhibitors exhibit a linear relationship between dose and area under the plasma concentration-time curve. Cholinesterase inhibitors are rapidly absorbed through the gastrointestinal tract, with time to peak concentration usually less than 2 hours; donepezil has the longest absorption time of 3 to 5 hours. Donepezil and tacrine are highly protein bound, whereas protein binding of rivastigmine and galantamine is less than 40%. Tacrine is metabolised by hepatic cytochrome P450 (CYP) 1A2, and donepezil and galantamine are metabolised by CYP3A4 and CYP2D6. Rivastigmine is metabolised by sulfate conjugation. Two cholinesterase enzymes are present in the body, acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). Tacrine and rivastigmine inhibit both enzymes, whereas donepezil and galantamine specifically inhibit AChE. Galantamine also modulates nicotine receptors, thereby enhancing acetylcholinergic activity at the synapse. These different pharmacological profiles provide distinctions between these agents. Cholinesterase inhibitors show a nonlinear relationship between dose and cholinesterase inhibition, where a plateau effect occurs. Cholinesterase inhibitors display a different profile as each agent achieves its plateau at different doses. In clinical trials, cholinesterase inhibitors demonstrate a dose-dependent effect on cognition and functional activities. Improvement in behavioural symptoms also occurs, but without a dose-response relationship. Gastrointestinal adverse events are dose-related. Clinical improvement occurs with between 40 and 70% inhibition of cholinesterase. A conceptual model for cholinesterase inhibitors has been proposed, linking enzyme inhibition, clinical efficacy and adverse effects. Currently, measurement of enzyme inhibition is used as the biomarker for cholinesterase inhibitors. New approaches to determining the efficacy of cholinesterase inhibitors in the brain could involve the use of various imaging techniques. The knowledge base for the pharmacokinetics and pharmacodynamics of cholinesterase inhibitors continues to expand. The increased information available to clinicians can optimise the use of these agents in the management of patients with Alzheimer's disease.

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Crossref · 10.2165/00003088-200241100-00003

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Citations

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Show all 105 references

Research works printed but not linked: 12

  1. Cutler, 1990, Psychopharmacol Bull, 26, 231
  2. Schran, 1996, Pharm Res, 13, S
  3. Johansson, 1993, Acta Neurol Scand, 149, 22
  4. Welty, 1993, Pharm Res, 10, S344
  5. Ravic, 2001, Clin Pharmacol Ther, 69, P44
  6. Reyes, 2001, Clin Pharmacol Ther, 69, P44
  7. DeJong, 1989, Clin Ther, 11, 545
  8. Knapp, 1994, JAMA, 271, 985, 10.1001/jama.1994.03510370037029 · DOI
  9. Corey-Bloom, 1999, Int J Geriatr Psychopharmacol, 1, 55
  10. Anand, 2000, Int J Geriatr Psychopharmacol, 2, 68
  11. Farlow, 1992, JAMA, 268, 2523, 10.1001/jama.1992.03490180055026 · DOI
  12. Steele, 1999, J Clin Outcome Management, 6, 52

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Metadata

Authors
Jann, M. W., Shirley, K. L., & Small, G. W.
Affiliations
  • Mercer University (US)
  • University of California, Los Angeles (US)
Corresponding author
Jann, Michael W.
ORCID
Venue
Clinical Pharmacokinetics
Publisher
Springer Science and Business Media LLC
Published
2002
Volume
41
Issue
10
Pages
719-739
ISSN
0312-5963 (ISSN-L)
DOI
10.2165/00003088-200241100-00003
OpenAlex
W2016149437
Cited by
365
References
105
Citations by year
2026: 9 · 2025: 10 · 2024: 13 · 2023: 11 · 2022: 10 · 2021: 12 · 2020: 19 · 2019: 23 · 2018: 11 · 2017: 7 · 2016: 17 · 2015: 17 · 2014: 23 · 2013: 11 · 2012: 16
FWCI
2.09
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Pharmacokinetics (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Eli Lilly and Company
  • Pfizer Pharmaceuticals
Topics
  • Health Sciences › Medicine › Pharmacology (medical) › Cholinesterase and Neurodegenerative Diseases
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
Keywords
cholinesterase inhibitors, Alzheimer's disease, pharmacokinetics, pharmacodynamics, tacrine, donepezil, rivastigmine, galantamine, acetylcholinesterase inhibition, butyrylcholinesterase, dose-response relationship, plateau effect, drug metabolism, cytochrome P450, protein binding, nicotinic acetylcholine receptors, biomarkers, neuroimaging
MeSH terms
Rivastigmine, Donepezil, Aging, Alzheimer Disease, Biological Availability, Carbamates, Cholinesterase Inhibitors, Drug Interactions, Half-Life, Humans, Indans, Intestinal Absorption, Liver, Piperidines, Protein Binding, Tacrine, Tissue Distribution, Phenylcarbamates

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