II. Mechanism
III. Indications
- Mild to Moderate Dementia (Folstein MMSE: 10-26)
IV. Adverse Effects
- See Acetylcholinesterase Inhibitor
- No hepatotoxicity
- Syncope and Torsades de Pointes (have been reported for Aricept, but not other Acetylcholinesterase Inhibitors)
V. Dosing
- Start at 5 mg orally at bedtime
- Increase to 10 mg orally at bedtime after 4-6 weeks
- Increase to 23 mg orally at bedtime after 3 weeks at 10 mg dose
VI. Advantages
- Generic Aricept is the least expensive of the Cholinesterase Inhibitors ($11 for 30 tablets in 2017)
VII. Efficacy
- See Acetylcholinesterase Inhibitor
- As effective as Cognex (without the hepatotoxicity risk)
-
Mini-Mental Status Exam changes
- Reduces decline by 3 points in 6 months
- Patient reverts to prior decline with Drug Withdrawal
- May be preferred over Galantamine
- Appears more effective than Galantamine
- Better tolerated than Galantamine
- Lanctot (2003) CMAJ 169:557-64 [PubMed]
- Long-term use of Donepezil has minimal to no effect
- Does not prevent Nursing Home placement
- Minimally improves cognition
- Does not protect against longterm functional decline
- Courtney (2004) Lancet 363:2105-15 [PubMed]
VIII. References
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Related Studies
| 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 |