donepezil

Class




  • Cholinesterase inhibitor




Donepezil


Commonly Prescribed for


(FDA approved in bold)



  • Alzheimer dementia (AD) (mild, moderate or severe)
  • Vascular dementia
  • Mild cognitive impairment
  • Dementia with Lewy bodies (DLB)
  • HIV dementia
  • Autism
  • Attention deficit hyperactivity disorder (ADHD)



Donepezil


How the Drug Works



  • Increases the concentration of acetylcholine through reversible, non-competitive inhibition of acetylcholinesterase, which increases availability of acetylcholine. A deficiency of cholinergic function is felt to be important in producing the signs and symptoms of AD. May interfere with amyloid deposition
  • Although symptoms of AD can improve, donepezil does not prevent disease progression



Donepezil


How Long Until It Works



  • Typically 2–6 weeks at a given dose, but effect is best observed over a period of months



Donepezil


If It Works



  • Continue to use but symptoms of dementia usually continue to worsen



Donepezil


If It Doesn’t Work



  • Non-pharmacologic measures are the basis of dementia treatment. Maintain regular schedules and routines. Avoid prolonged travel, unnecessary medical procedures or emergency room visits, crowds, and large social gatherings
  • Limit drugs with sedative properties such as opioids, hypnotics, Antiepileptic drugs and tricyclic antidepressants
  • Consider adjusting dose
  • Treat other disorders which can worsen symptoms such as hyperglycemia or urinary difficulties



Donepezil


Best Augmenting Combos for Partial Response or Treatment-Resistance



  • Addition of the NMDA receptor antagonist memantine may be beneficial. In 1 study donepezil plus memantine reduced the rate of progression compared to those taking donepezil alone
  • Treat depression or apathy, if present, with SSRIs. Avoid tricyclic antidepressants in demented patients due to risk of confusion
  • For significant confusion and agitation avoid neuroleptics (especially in Lewy Body dementia) to avoid the risk of neuroleptic malignant syndrome. Atypical antipsychotics (risperidone, quetiapine, olanzapine, clozapine) can be used instead



Donepezil


Tests



  • None required



Adverse Effects (AEs)




Donepezil


How Drug Causes AEs



  • Acetylcholinesterase inhibition in the CNS and PNS



Donepezil


Notable AEs



  • GI AEs (nausea, diarrhea, anorexia and weight loss) are most common
  • Fatigue, depression, dizziness, muscle cramps and sleep disturbances



Donepezil


Life-Threatening or Dangerous AEs



  • Rarely bradycardia or heart block causing syncope. Generalized convulsions. Increases gastric acid secretions which can predispose to GI bleeding



Donepezil


Weight Gain



  • Unusual


  • Weight loss is more common



Donepezil


Sedation



  • Unusual



Donepezil


What to Do About AEs

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Feb 16, 2017 | Posted by in PHARMACY | Comments Off on donepezil

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