II. Background
- Replaced by newer agents (e.g. Aricept) - avoid use due to hepatotoxicity risk
III. Indications
- No longer used in U.S. due to hepatotoxicity risk
- Mild to Moderate Dementia (Folstein MMSE: 10-26)
IV. Mechanism
- First Acetylcholinesterase Inhibitor
- Other agents are now preferred
V. Efficacy
- Response in 20% of patients
- Aricept offers similar efficacy and less toxicity
VI. Dosing
- Start at 10 mg PO qid for 4 weeks
- Increase to 20 mg PO qid for 4 weeks
- Titrate to maximum of 40 mg
VII. Adverse effects
- Hepatotoxicity
- Follow Liver Function Tests (esp. SGPT) every 2 weeks