Aricept

Aka: Aricept, Donepezil, Namzaric

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II. Indications

  1. Mild to Moderate Dementia (Folstein MMSE: 10-26)

III. Mechanism

  1. Acetylcholinesterase Inhibitor

IV. Medications

  1. Donepezil alone
    1. Donepezil Hydrochloride Tablet (or ODT): 5 mg, 10 mg
    2. Donepezil Extended Release: 23 mg
  2. Donepezil combination with Memantine (Namenda)
    1. Donepezil Hydrochloride AND Memantine hydrochloride: 10 mg/7 mg, 10 mg/14 mg, 10 mg/21 mg, 10 mg/28 mg
    2. Donepezil Hydrochloride AND Memantine Extended Release (Namzaric): 10 mg/14 mg, 10 mg/28 mg

V. Dosing: Donepezil

  1. Start at 5 mg orally at bedtime
  2. Increase to 10 mg orally at bedtime after 4-6 weeks
  3. May increase to the sustained release 23 mg orally at bedtime after 3 weeks at 10 mg dose
    1. However, may be no more effective than 10 mg dose (and with greater adverse effects)

VI. Adverse Effects

  1. See Acetylcholinesterase Inhibitor
  2. No hepatotoxicity
  3. Cardiovascular
    1. Syncope
    2. QTc Prolongation (and Torsades de Pointes)
      1. Have been reported for Aricept (but not other Acetylcholinesterase Inhibitors)
    3. Atrioventricular Block
    4. Bradycardia
  4. Gastrointestinal
    1. Diarrhea
    2. Nausea or Vomiting
    3. Decreased appetite and Weight loss
  5. Neuropsychiatric
    1. Headache
    2. Myalgias
    3. Dizziness and Fall Risk
    4. Somnolence
    5. Vivid dreams

VII. Efficacy

  1. See Acetylcholinesterase Inhibitor
  2. Generic Aricept is the least expensive of the Cholinesterase Inhibitors ($11 for 30 tablets in 2017)
    1. Most commonly prescribed Acetylcholinesterase Inhibitor
    2. As effective as Cognex (without the hepatotoxicity risk)
  3. Mini-Mental Status Exam changes
    1. Reduces decline by 3 points in 6 months
    2. Patient reverts to prior decline with Drug Withdrawal
  4. May be preferred over Galantamine
    1. Appears more effective than Galantamine
    2. Better tolerated than Galantamine
    3. Lanctot (2003) CMAJ 169:557-64 [PubMed]
  5. Long-term use of Donepezil has minimal to no effect
    1. Does not prevent Nursing Home placement
    2. Minimally improves cognition
    3. Does not protect against longterm functional decline
    4. Courtney (2004) Lancet 363:2105-15 [PubMed]

VIII. Resources

  1. Donepezil Hydrochloride Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=98e451e1-e4d7-4439-a675-c5457ba20975

IX. References

  1. Epperly (2017) Am Fam Physician 95(12): 771-8 [PubMed]
  2. Birks (2018) Cochrane Database Syst Rev (6): CD001190 [PubMed]
  3. Jaqua (2024) Am Fam Physician 110(3): 281-93 [PubMed]

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Cost: Medications

donepezil (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DONEPEZIL HCL 10 MG TABLET Generic $0.05 each
DONEPEZIL HCL 23 MG TABLET Generic $0.66 each
DONEPEZIL HCL 5 MG TABLET Generic $0.04 each
DONEPEZIL HCL ODT 10 MG TABLET Generic $0.29 each
DONEPEZIL HCL ODT 5 MG TABLET Generic $0.33 each
namzaric (on 1/14/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
NAMZARIC 14 MG-10 MG CAPSULE $17.18 each
NAMZARIC 21 MG-10 MG CAPSULE $17.14 each
NAMZARIC 28 MG-10 MG CAPSULE $17.19 each
NAMZARIC 7 MG-10 MG CAPSULE $17.15 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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