What is the use of Donepezil (Aricept)?

From the Guidelines

Donepezil should be considered for the treatment of mild to moderate Alzheimer's disease and vascular dementia, as it has shown a statistically significant treatment effect on cognition and daily living activities, despite the average change in cognitive scores not reaching a clinically significant level 1. The medication is a cholinesterase inhibitor, which increases levels of acetylcholine in the brain, a neurotransmitter important for memory and thinking.

• The standard dosages evaluated in studies ranged from 5 mg/d to 10 mg/d, with most studies using a dosage of 10 mg/d 1.
• The duration of treatment varied from 12 to 156 weeks, with some studies showing positive effects on cognition and daily living activities after 23 to 24 weeks of treatment 1.
• Common side effects of donepezil include nausea, diarrhea, insomnia, vomiting, muscle cramps, fatigue, and decreased appetite, which are often mild and temporary.
• It is essential to take donepezil regularly as prescribed, even if symptoms don't immediately improve, as benefits may take weeks to become noticeable.
• Patients should inform their healthcare provider about all other medications they're taking to avoid potential interactions, particularly with certain antipsychotics, antiarrhythmics, and anticholinergic drugs.
• While donepezil does not cure or stop the progression of Alzheimer's disease, it can temporarily improve cognitive function and daily living activities in some patients, making it a valuable treatment option for those with mild to moderate Alzheimer's disease and vascular dementia 1.

From the FDA Drug Label

Donepezil is an acetylcholinesterase inhibitor indicated for the treatment of dementia of the Alzheimer’s type. Efficacy has been demonstrated in patients with mild, moderate, and severe Alzheimer’s Disease (1)

The primary use of Donepezil is for the treatment of dementia of the Alzheimer's type, with demonstrated efficacy in patients with mild, moderate, and severe Alzheimer's Disease 2.

• Indications: Treatment of dementia of the Alzheimer's type
• Patient population: Patients with mild, moderate, and severe Alzheimer's Disease
• Mechanism of action: Acetylcholinesterase inhibitor

From the Research

Donepezil Overview

• Donepezil is an acetylcholinesterase inhibitor approved for use across the full spectrum of mild, moderate, and severe Alzheimer's disease (AD) 3.
• It has been available at doses of 5 or 10 mg once daily for more than a decade, and a single high once-daily sustained-release 23-mg dose has been approved for treatment of patients with moderate to severe AD 3.

Efficacy and Safety

• Donepezil has been found to delay nursing-home placement and result in caregiver respite in patients with AD 4.
• It slows deterioration of cognition and global function in patients with moderate-to-severe AD, with improvement of abnormal behaviours 4.
• Treatment with donepezil resulted in significantly better cognitive performance using the ADAS-cog scale when compared with placebo 5.
• Donepezil can delay cognitive impairment in patients with mild to moderately-severe AD for at least 6 months duration 5.
• The cholinesterase inhibitors, including donepezil, can stabilize or slow decline in cognition, function, behavior, and global change 6.

Adverse Events and Tolerability

• Initial side effects of donepezil include nausea, vomiting, diarrhoea, insomnia, muscle cramps, fatigue, anorexia, and syncope 4.
• Caution is advised in patients with bradycardia 4.
• Adverse events were generally related to the gastrointestinal system, with a tendency for these to be more common in the treatment arms 5.
• Donepezil-treated subjects had a lower risk of gastrointestinal adverse events compared with rivastigmine or galantamine 7.
• Subjects with mild to moderate AD treated with donepezil were more adherent to pharmacotherapy and had a lower risk of gastrointestinal adverse events compared with rivastigmine or galantamine 7.