Aricept

Action

Reversibly inhibits acetylcholinesterase hydrolysis in CNS, leading to increased acetylcholine level and temporary cognitive improvement in patients with Alzheimer's disease

Availability

Tablets: 5 mg, 10 mg, 23 mg

Tablets (orally disintegrating): 5 mg, 10 mg

Indications and dosages

➣ Mild to moderate Alzheimer's disease

Adults: Initially, 5 mg P.O. daily. After 4 to 6 weeks, may increase dosage to 10 mg at bedtime.

➣ Moderate to severe Alzheimer's disease

Adults: Initially, 10 mg P.O. daily. After 3 months, may increase dosage to 23 mg.

Contraindications

• Hypersensitivity to drug or piperidine derivatives

Precautions

Use cautiously in:

• cardiovascular disease, chronic obstructive pulmonary disease (COPD), asthma, or sick sinus syndrome

• patients at risk for developing ulcers, such as those with history of ulcer disease or those concurrently receiving NSAIDs

• pregnant or breastfeeding patients

• children (safety and efficacy not established).

Administration

• Give with or without food.

• For best response, give at bedtime.

Adverse reactions

CNS: headache, dizziness, vertigo, fatigue, depression, aggression, irritability, restlessness, nervousness, paresthesia, insomnia, abnormal dreams, tremor, aphasia, seizures

CV: chest pain, bradycardia, hypertension, hypotension, vasodilation, atrial fibrillation, heart block

EENT: cataracts, blurred vision, eye irritation, sore throat

GI: nausea, vomiting, diarrhea, anorexia, bloating, epigastric pain, fecal incontinence, GI bleeding

GU: urinary frequency, increased libido, bladder outflow obstruction

Metabolic: dehydration

Musculoskeletal: muscle cramps, arthritis, bone fracture

Respiratory: dyspnea, bronchitis

Skin: pruritus, urticaria, bruising, diaphoresis, rash, flushing

Other: toothache, decreased appetite, weight loss, hot flashes, influenza

Interactions

Drug-drug. Anticholinergics: reduced donepezil effects

Anticholinesterases, cholinomimetics: synergistic effects

Carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin: accelerated donepezil elimination

NSAIDs: increased risk of GI bleeding

Patient monitoring

☞ Watch closely for increased bronchoconstriction in patients with history of asthma or COPD.

• Assess cardiovascular status. Drug may cause bradycardia from increased vagal tone.

• Monitor closely for signs and symptoms of GI ulcers and bleeding, especially if patient takes NSAIDs concurrently.

Patient teaching

• Advise patient to take drug at bedtime with or without food.

• Instruct patient to allow orally disintegrating tablet to dissolve under tongue and then follow with a glass of water.

• Tell patient not to split, crush, or chew 23-mg tablet.

• Inform patient that drug may slow the heart rate, leading to fainting episodes.

☞ Instruct patient to immediately report signs or symptoms of GI ulcers ("coffee-ground" vomitus, black tarry stools, and abdominal pain), or irregular heartbeat.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.