What is the dose and frequency of Theracran (active ingredient unknown, possibly a cholinesterase inhibitor like donepezil) for an elderly female patient with dementia?

Donepezil Dosing for Elderly Female with Dementia

Start donepezil at 5 mg once daily in the evening, then increase to 10 mg once daily after 4-6 weeks if well tolerated. 1

Initial Dosing

• Begin with 5 mg once daily in the evening, just prior to retiring. This is the FDA-approved starting dose for all patients with Alzheimer's disease regardless of age or sex. 1
• The medication can be taken with or without food, though taking it with food reduces gastrointestinal side effects. 2, 1
• Do not administer the 10 mg dose until the patient has been on 5 mg daily for 4-6 weeks. 1, 3

Dose Escalation

• After 4-6 weeks on 5 mg daily, increase to 10 mg once daily if the patient tolerates the initial dose well. 1, 4
• The 10 mg dose is more efficacious than 5 mg and is the maximum recommended dose for mild to moderate dementia. 2, 1
• Higher doses (15-20 mg) show dose-dependent increases in gastrointestinal side effects, particularly nausea (relative risk 2.54), vomiting, and diarrhea (relative risk 2.57). 3

Monitoring Timeline

• Assess response after 3 months of treatment, as beneficial effects are generally observed within this timeframe. 4
• Benefits on cognitive function and activities of daily living can be maintained for approximately 21-81 weeks with donepezil 10 mg/day. 3, 5
• A comprehensive assessment period of 6-12 months is necessary to fully evaluate potential benefit. 4

Managing Side Effects in Elderly Females

• Monitor closely for gastrointestinal symptoms (nausea, vomiting, diarrhea) and weight loss, which are more common at 10 mg than 5 mg. 1, 3
• Watch for initial increase in agitation, which typically subsides after the first few weeks of therapy. 2, 3
• Be alert for cardiovascular effects including bradycardia and heart block, as cholinesterase inhibitors have vagotonic effects on cardiac conduction. 1
• Gradual dose titration over 4-6 weeks minimizes side effects compared to rapid escalation. 2, 5

Common Pitfalls to Avoid

• Do not start at 10 mg daily, as this increases the risk of intolerable side effects and treatment discontinuation. 1
• Do not administer at bedtime if sleep disturbances occur; the FDA label specifies evening administration "just prior to retiring," but timing can be adjusted if insomnia develops. 1
• Do not expect dramatic improvement—effects are statistically significant but modest in magnitude, typically showing a 5-15% benefit over placebo. 2, 3
• Do not discontinue prematurely; some patients require up to 12 months to demonstrate benefit. 4

When to Consider Adding Memantine

• If the patient continues to decline after 3 months on donepezil 10 mg daily, add memantine 20 mg/day while continuing donepezil. 4
• Combination therapy is recommended for patients with moderate to severe disease who are not responding adequately to monotherapy. 4