Aricept

Aka: Aricept, Donepezil

1. See Also
   1. Acetylcholinesterase Inhibitor
   2. Dementia
   3. Dementia Management
   4. Rivastigmine (Exelon)
   5. Galantamine (Reminyl)
2. Mechanism
   1. Acetylcholinesterase Inhibitor
3. Indications
   1. Mild to Moderate Dementia (Folstein MMSE: 10-26)
4. Adverse Effects
   1. See Acetylcholinesterase Inhibitor
   2. No hepatotoxicity
   3. Syncope and Torsades de Pointes (have been reported for Aricept, but not other Acetylcholinesterase Inhibitors)
5. Dosing
   1. Start at 5 mg orally at bedtime
   2. Increase to 10 mg orally at bedtime after 4-6 weeks
   3. Increase to 23 mg orally at bedtime after 3 weeks at 10 mg dose
6. Advantages
   1. Generic Aricept is the least expensive of the Cholinesterase Inhibitors ($11 for 30 tablets in 2017)
7. Efficacy
   1. See 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]
8. References
   1. Epperly (2017) Am Fam Physician 95(12): 771-8 [PubMed]