What is the use of Donepezil (Aricept)?

From the Guidelines

Donepezil is a medication primarily used to treat symptoms of mild to moderate Alzheimer's disease, with the standard starting dose being 5 mg taken once daily at bedtime, which may be increased to 10 mg daily after 4-6 weeks if well tolerated 1. The medication belongs to a class of drugs called cholinesterase inhibitors, which work by increasing levels of acetylcholine in the brain, a neurotransmitter important for memory and thinking.

Key Points

• The standard starting dose is 5 mg taken once daily at bedtime, which may be increased to 10 mg daily after 4-6 weeks if well tolerated 1.
• For severe Alzheimer's, doses up to 23 mg daily may be prescribed, but this should be done under close medical supervision.
• Common side effects include nausea, diarrhea, insomnia, vomiting, muscle cramps, fatigue, and decreased appetite, which are often mild and temporary 1.
• Donepezil doesn't cure Alzheimer's disease but can temporarily improve cognitive function or slow cognitive decline in some patients, with the best results seen when started early in the disease course 1.
• Patients should be monitored regularly to assess the medication's effectiveness and manage any side effects, with adjustments to the dose as needed 1.

Administration and Monitoring

• Donepezil should be taken with or without food at the same time each day to maintain consistent blood levels.
• Regular monitoring of the patient's condition, including cognitive function and any side effects, is crucial to determine the effectiveness of the treatment and to make any necessary adjustments to the dose or treatment plan 1.

From the FDA Drug Label

DONEPEZIL HYDROCHLORIDE tablets, for oral use Initial U. S. Approval: 1996 INDICATIONS AND USAGE 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 use of Donepezil (Aricept) is for the treatment of dementia of the Alzheimer's type, with efficacy demonstrated in patients with mild, moderate, and severe Alzheimer's Disease 2.

• Key uses:
  • Treatment of dementia of the Alzheimer's type
  • Management of mild, moderate, and severe Alzheimer's Disease
• Mechanism of action: Acetylcholinesterase inhibitor

From the Research

Use of Donepezil (Aricept)

• Donepezil is licensed for the treatment of mild-to-moderate Alzheimer's disease (AD) at doses of 5-10 mg/day and has recently been approved in the US for severe AD 3.
• Donepezil is an acetylcholinesterase inhibitor approved for use across the full spectrum of mild, moderate, and severe AD 4.
• The primary use of donepezil is to enhance cholinergic neurotransmission in the brain by blocking the action of the enzyme responsible for the breakdown of the neurotransmitter acetylcholine, which can help to improve cognitive function in people with Alzheimer's disease 5.

Dose Optimization

• Higher doses of donepezil, such as 15 and 20 mg/day, have been shown to be safe and well-tolerated in patients with mild-to-moderate AD 3.
• A 23-mg dose of donepezil has been approved for treatment of patients with moderate to severe AD, with benefits being most apparent in patients with more advanced AD 4.
• The efficacy and safety of different doses of donepezil have been compared in several studies, with results suggesting that higher doses may provide additional benefits for patients with AD 5, 6.

Clinical Relevance

• Donepezil has been shown to improve cognitive function, activities of daily living, and global clinical state in people with mild, moderate, or severe dementia due to Alzheimer's disease 5.
• Donepezil may also have therapeutic benefits for other neurological conditions, such as vascular dementia 7.
• The use of donepezil at higher doses is justified given the worsening cholinergic deficit as the disease advances, and may provide demonstrable benefits for patients with moderate-to-severe AD 6.