<unk>  is indicated for the treatment of mild to moderate vascular dementia and Alzheimer's. In the United States, it is approved by the Food and Drug Administration as safe and effective for the treatment of mild to moderate dementia. As with other cholinesterase inhibitors,<unk>  may not be effective for treating mild cognitive impairment. The FDA considers<unk>  to have dual status as a prescription drug and as a OTC dietary supplement. Alzheimer's disease Alzheimer's disease is characterized by the impairment of cholinergic function. One hypothesis is that this impairment contributes to the cognitive deficits caused by the disease. This hypothesis forms the basis for use of<unk>  as a cholinergic enhancer in the treatment of Alzheimer's.<unk>  inhibits acetylcholinesterase, an enzyme which hydrolyzes acetylcholine. As a result of acetylcholinesterase inhibition,<unk>  increases the availability of acetylcholine for synaptic transmission. Additionally,<unk>  binds to the allosteric sites of nicotinic receptors, which causes a conformational change. This allosteric modulation increases the nicotinic receptor's response to acetylcholine. The activation of presynaptic nicotinic receptors increases the release of acetylcholine, further increasing the availability of acetylcholine.<unk> 's competitive inhibition of acetylcholinesterase and allosteric nicotinic modulation serves as a dual mechanism of action. To reduce the prevalence of negative side effects associated with<unk> , such as nausea and vomiting, a dose-escalation scheme may be used. The use of a dose-escalation scheme has been well accepted in countries where<unk>  is used. A dose-escalation scheme for Alzheimer's treatment involves a recommended starting dosage of 4 mg<unk>  tablets given twice a day (8 mg/day). After a minimum of 4 weeks, the dosage may then be increased to 8 mg given twice a day (16 mg/day). After a minimum of 4 weeks at 16 mg/day, the treatment may be increased to 12 mg given twice a day (24 mg/day). Dosage increases are based upon the assessment of clinical benefit as well as tolerability of the previous dosage. If treatment is interrupted for more than three days, the process is usually restarted, beginning at the starting dosage, and re-escalating to the current dose. It has been found that a dosage between 16–24 mg/day is the optimal dosage. Available forms The product is supplied in prescription form only in twice-a-day tablets, in once-a-day extended-release capsules, and in oral solution.
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