Treatment of Alzheimer's Dementia with Aricept Generic (Donepezil)

Aricept is a drug that contains an active substance called Donepezil. It belongs to the group of drugs used to treat dementia. Aricept Generic works by inhibiting acetylcholinesterase, the main enzyme in the brain. In vitro studies have proved Aricept Donepezil to be more than 1000 times potent inhibitor of this enzyme than butyrylcholinesterase, an enzyme that is mainly present outside the central nervous system.

Aricept Donepezil is indicated for the treatment of Alzheimer's dementia. In patients with Alzheimer's disease who participated in clinical studies, the use of Aricept in a single daily dose of 5mg or 10mg led to inhibition of acetylcholinesterase activity (measured in erythrocyte membranes) by 65%. The degree of inhibition of acetylcholinesterase has been shown to be in correlation with changes in the ADAS-Cog scale, a sensitivity scale for examining selected cognitive aspects.

The potential of Aricept Generic to influence the course of existing neuropathology has not been investigated and therefore this drug cannot be considered to have an impact on the progression of the disease itself. Therefore, patients must be aware that the medicine cannot stop exacerbation of Alzheimer's disease, but it can certainly improve symptoms.

The efficacy of Aricept Donepezil was demonstrated in four placebo-controlled studies, of which two studies lasted six months, and two studies lasted one year. In a study that lasted six months, three criteria were used to evaluate the efficacy of the Aricept therapy: the ADAS-Cog scale (for measuring cognitive parameters), CIBIC (Clinical Interview Based Impression of Change plus Caregiver's Input) - a clinical interview based on observations of changes by a person who takes care of Alzheimer's patients (measuring the patient's ability to work, hobbies and personal care). All studies have shown that Aricept Donepezil is very effective in improving symptoms and quality of life of Alzheimer's patients.

What Dosage to Take

The treatment should be started with 5mg daily. It is best to take Aricept Donepezil before bedtime, with one full glass of regular water.

After one month of therapy, a dose may be increased up to 10 mg once daily as needed. Maximal daily dosage is 10mg. Doses higher than 10mg daily have not been used in clinical trials therefore high doses are not recommended.

Aricept Generic is mostly metabolized through liver and very small amounts are excreted via kidneys. Therefore, dosage adjustments are not needed in patients with impaired renal function. However, dose in patients who have impaired liver function must be reduced. Talk to your doctor if you have or have had liver problems.

Aricept is not recommended for use in children under the age of 18.

Precautions

Aricept Donepezil is a cholinesterase inhibitor, and therefore it may enhance the muscle-relaxing effects of Succinylcholine during anesthesia. Inform your doctor that you are taking Aricept Generic prior any surgical procedure.

Aricept Donepezil may cause slow heart rate also known as bradycardia. This is especially important for patients who already have slow heart rate such as patients suffering from atrioventricular block of any degree. Some drugs may also slow heart rate (e.g. beta blockers such as Propranolol, Atenolol, Metoprolol, etc., and calcium channel blockers such as Verapamil) thus the concomitant use with these drugs must be avoided.

Patients who are at high risk of developing ulcer, e.g. patients with a history of ulcer disease or patients who simultaneously administer non-steroidal anti-inflammatory drugs (NSAIDs) should use Aricept with extra precaution. If you notice symptoms of peptic or duodenal ulcer, such as abdominal pain, decreased appetite, presence of blood in the stool, etc., you must contact your doctor immediately. However, clinical studies have not shown increased risk of peptic or duodenal ulcer in patients who were taking Aricept compared to group of patients taking placebo. Aricept Generic can cause obstruction of the urinary tract, so patients should inform their physician if they already have urinary tract disorders.

Although not confirmed in clinical studies, it is believed that Aricept Donepezil may cause generalized convulsions, but it is still not clear whether these convulsions are caused by Alzheimer's disease or by Aricept. Further studies are needed to determine the risk of convulsions.

Aricept Donepezil can very rarely cause motor restlessness, slowness of movements, tremor, and tardive dyskinesia (these symptoms are known as extrapyramidal symptoms).

Aricept should be used with extra precaution in patients who suffer from asthma or chronic obstructive pulmonary disease (COPD). There are no data on safety of this drug in patients who have severe hepatic impairment therefore use of Aricept in individuals who have severe liver damage must be avoided.

Drug Interactions

There are 7 major, 600 moderate and 175 minor interactions reported so far. Aricept Donepezil should not be used concomitantly with following drugs:

• Opioid analgesics, such as Tramadol, Morphine, and Fentanyl. The concomitant use with these drugs increases risk of convulsions.
• Bupropion - an antidepressive agent commonly used as a smoking cessation aid. Bupropion may increase your risk of developing convulsions thus the concomitant use with Aricept must be avoided.
• Metrizamide - a nonionic radiopaque contrast agent. The concomitant use increases risk of developing seizures.
• Antifungal drugs, such as Itraconazole, Ketoconazole, and Fluconazole. These drugs inhibit CYP3A4 enzyme (the enzyme responsible for metabolism of Aricept) and may increase blood levels of Donepezil thus leading to increased risk of adverse effects.
• Carbamazepine - a drug used to treat epilepsy. This medicine induces CYP3A4 and decreases blood levels of Aricept thus decreasing its effectiveness.

Inform your doctor if you are taking any other medicines.

Pregnancy and Breastfeeding

Animal studies showed no teratogenic effects of Aricept Donepezil, but there are some data indicating that the drug may cause post-natal toxicity. Therefore, Aricept should not be used during pregnancy, unless your doctor recommended.

Aricept Donepezil is excreted in milk of rats. It is not known whether it is excreted in breast milk therefore breastfeeding should be discontinued while taking this medicament.

Adverse Effects

Aricept Donepezil may cause following side effects:

• Cold;
• Anorexia;
• Hallucinations;
• Aggressive behavior;
• Syncope;
• Seizures;
• Slow heart rate;
• Nausea;
• Vomiting;
• Itchy skin;
• Atrioventricular block;
• Muscle cramps;
• Urinary retention;
• Headache;
• Diarrhea;
• Liver damage;
• Hepatitis;
• Tardive dyskinesia;
• Slowness of movements;
• Allergic reactions.

Inform your physician if you notice any side effects.