II. Background

  1. Replaced by newer agents (e.g. Aricept) - avoid use due to hepatotoxicity risk

III. Indications

  1. No longer used in U.S. due to hepatotoxicity risk
  2. Mild to Moderate Dementia (Folstein MMSE: 10-26)

IV. Mechanism

  1. First Acetylcholinesterase Inhibitor
  2. Other agents are now preferred

V. Efficacy

  1. Response in 20% of patients
  2. Aricept offers similar efficacy and less toxicity

VI. Dosing

  1. Start at 10 mg PO qid for 4 weeks
  2. Increase to 20 mg PO qid for 4 weeks
  3. Titrate to maximum of 40 mg

VII. Adverse effects

  1. Hepatotoxicity
    1. Follow Liver Function Tests (esp. SGPT) every 2 weeks

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