Nonconventional Pharmacologic Treatment

Many other nonconventional treatments have been used as adjunctive treatments during the course of AD. Vitamin E has often been recommended for use as an ad-junctive treatment because of its antioxidant properties.40 It has potential effectiveness, a favorable side-effect profile, and low cost. The maintenance dose of vitamin E should be titrated to 1,000 IU twice daily. However, a recent meta-analysis suggests that high doses (greater than 400 IU/day) of vitamin E should be avoided due to an increased all-cause mortality.41 Estrogen has been investigated for use in AD, but as mentioned previously, was associated with an increased risk of dementia. Nonsteroidal anti-inflammatory drugs (NSAIDs) have also been investigated for their place in the therapy of AD. There is a lack of convincing data and significant adverse effects (gastritis and GI bleeds) associated with their use, so they are not recom-

mended for general use in the treatment or prevention of AD at this time. Statins (3-hydroxy-3-methylglutaryl-CoA reductase inhibitors) should be reserved for those patients who have other indications for their use.43 Ginkgo biloba has also been studied for its potential use in AD. Until this product has a more standardized manufacturing process and until its long-term safety and efficacy are established, it should be recommended with caution.44

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