Medical Food

As seen in the Consultant Connection December 2012 Issue
By: Scott Spitnale ONU Pharm D Candidate
For many years patients have joked about taking so many medications that it feels like a meal. Now that Axona, a new prescription food, is available, that joke has now become a reality. Newly approved by the FDA, Axona is a prescription food that is used to help treat Alzheimer’s. In an individual who is not suffering from Alzheimer’s, glucose is the main energy source for the brain.1 Patients who suffer from Alzheimer’s have shown a decrease in the amount of glucose utilized by the brain. The change in glucose utilization occurs early in Alzheimer’s, before symptoms appear. As the decrease in use of glucose continues, clinical symptoms begin to develop, and the glucose utilization decreases further. It was then demonstrated that increasing blood glucose in individuals could increase patient’s recall. As increased blood glucose levels for long periods of time can demonstrate long term side effects another approach was needed. 1

Axona provides unique ketone bodies that are metabolized by the liver to form -hydroxybutrate (BHB) which then can cross the blood brain barrier and be utilized as an alternative energy source.1,2 BHB can provide up to 60% of the energy required by the brain.2 In Alzheimer’s a decrease ranging from 20% to 40% of glucose utilization can be observed.3 The increase in levels of an alternative energy source led to an increase of memory recall.3 BHB, when tested in rats, demonstrated the ability to maintain neurons during periods of hypoglycemia.3 Axona demonstrated a significant improvement in The Alzheimer’s Disease Assessment Scale-Cognition at one and a half months and three month time periods.4 Axona is not for everyone. Axona is only approved in mild to moderate Alzheimer’s disease and contains ingredients that are milk and soy based.1 Patients who are allergic to milk or soy based products should not use Axona. Axona should not be used in patients who are at risk of ketoacidosis such as uncontrolled diabetics and those with a history of alcohol abuse.1 Patients that should not take Axona also include those with a history of metabolic disorder, gastric inflammation, and renal disorders.1 Side effects that may occur while taking Axona include: flatulence, diarrhea, indigestion, headache, abdominal pain, and dizziness.1 Axona’s side effects tend to be reduced if taken fifteen to thirty minutes after a meal. Most side effects were mild and gastrointestinal in nature.1 Axona may be used as an add on therapy to other Alzheimer’s disease medications.1

In summary, Axona can be beneficial to patients with mild to moderate Alzheimer’s Disease. Axona is a prescription only food that is to be dispensed from a pharmacy after receiving a prescription from a doctor. Axona has shown improvements in Alzheimer’s disease patients in as little as forty five days. Since Axona is a relatively new product no long term studies have been done at this point.

1. Axona [prescribing information]. Broomfield, CO: Accera, Inc.; May 2009. 2. Prins ML. Cerebral metabolic adaptation and ketone metabolism after brain injury. J Cereb Blood Flow Metab. 2008;28(1):1-16. 3. Reger MA, Henderson ST, Hale C, et al. Effects of β-hydroxybutyrate on cognition in memory-impaired adults. Neurobiol Aging. 2004;25(3):311-314. 4. Henderson ST, Vogel JL, Barr LJ, et al. Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer’s disease: a randomized, double-blind, placebo-controlled, multicenter trial. Nutr Metab (Lond). 2009;6:31.

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