ARICEPT SIDE EFFECTS IN THE ELDERLY:
What is Aricept?
What is it used for?
ARICEPT is a prescription medicine to treat mild, moderate, and severe Alzheimer’s disease. It improves mental functions (such as attention, memory, and the ability to interact and speak with others).
Your provider might use it off label to treat other forms of dementia such as Parkinson disease–related dementia, Lewy body dementia, and vascular dementia.
How does it work?
Aricept (donepezil hydrochloride) is a reversible inhibitor of the enzyme acetylcholinesterase.
What does that mean?
Aricept is thought to increase acetylcholine levels in the brain by preventing the breakdown of acetylcholine. This can increase the communication between remaining healthy nerve cells in the brain, and help improve cognition and function in patients with Alzheimer’s disease.
Aricept does not cure Alzheimer’s disease. All patients with Alzheimer’s disease get worse over time, even if they take Aricept
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Can Aricept improve memory?
Aricept has potential benefit in delaying risk of progression to Alzheimer’s disease in the first year of treatment, but this benefit is not seen at 3 years. Donepezil does not improve memory for patients with mild cognitive impairment
How to take the drug?
• Take ARICEPT one time each day. ARICEPT can be taken with or without food.
• ARICEPT 23 mg tablets should be swallowed whole. Do not split, crush, or chew the tablet.
o Mild-to-moderate AD : Initially 5mg daily at bedtime, may increase to max 10 mg daily after 4–6 weeks,
o Moderate-to-severe: initially 5mg daily at bedtime, may increase to 10 mg daily after 4–6 weeks; may further increase to max 23 mg daily after 3 months; usual dose: 10mg or 23 mg once daily.
How to stop the drug?
Do not suddenly discontinue the drug as it sometimes can cause intense hallucinations in some patients. I generally taper the drug by 50% every 2 weeks. If your loved one is on 10mg , your health care provider can reduce the dose to 5 mg for 2 weeks and then discontinue the medication. If your loved one is on 23mg then would your health care provider can reduce the dose to 10 mg for 2 weeks, then 5 mg for 2 weeks.
Why would my doctor stop the drug?
- Especially with advancing dementia when your loved one is unable to take or swallow the medication.Your loved one refuses to take the medication.
- There is no response to the therapy.
- There are significant side effects from the medication such as weight loss.
- The potential benefit is no longer there, especially in advanced dementia the risks of taking the drug outweigh the benefits.
- Your provider can sit down and talk to you about what to expect and discuss alternate approaches to managing symptoms.
Can Aricept make dementia worse?
What I tell my patients and caregivers : This medication effects everybody differently and in some patients it can cause drowsiness, sleepiness as well as paradoxical agitation. In that case we will have a conversation whether the risks of taking the mediation outweigh the benefits.
What are the most common side effects?
- nausea
- diarrhea
- not sleeping well
- vomiting
- muscle cramps
- feeling tired
- not wanting to eat
What are serious side effects?
- Slow heartbeat(bradycardia) and fainting ( syncope). This can happen esp. with patients with underlying heart problems. Call your doctor right away if you feel faint or lightheaded while taking Aricept.
- Increased stomach acid production. This raises the chance of ulcers and bleeding, especially when taking ARICEPT 23 mg. The risk is higher for people who have had ulcers or take aspirin or other NSAIDs. You might even notice blood in your stool or black tarry stool.
- Worsening of lung problems in people with asthma or another lung disease such as COPD.
- Seizures.
- Difficulty passing urine.
In medicine, an unintended consequence of a drug, whether therapeutic or adverse, that is secondary to the one intended; is referred to as a side effect.
Sometimes the term adverse event is used. The effects on drugs are very different with various individuals as many factors have to be taken into account: everything from the physiology of the individual, dietary habits as well as their demographics to the pharmacodynamics and pharmacokinetics of the drug. Consequently, no two people will have the same experience.
So even drugs which are listed with no side effects might be consequential for other individuals. Most drugs, unfortunately, have systemic side effects as it is difficult to make a drug to target specific places of the body. Looking at a cross section of individuals both during trials as well as following up on post marketing surveys, pharmaceutical companies have a vested interest together with regulatory bodies to monitor for adverse events. A drug side effect listed as high as 10 % in certain individuals per survey data reflect an overall average of reported side effects, and thus consequently can or cannot translate to the general population.
Interestingly, certain individuals are poor metabolizers of drugs.
Variations in metabolism, however, can be particularly important with drugs that have a narrow margin of safety. Hopefully, in the future, advances in molecular genetics will help predict drug sensitivities.
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