Names and pronunciation
(doe-nep′i-zill) Aricept, Aricept ODT
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Individual generic drug information
Extracted information for donepezil only.
(doe-nep′i-zill) Aricept, Aricept ODT
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Func. class.: Anti-Alzheimer’s agent
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Chem. class.: Reversible cholinester- ase inhibitor
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Do not confuse: Aricept/Aciphex/Azilect
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ACTION: Elevates acetylcholine con- centrations (cerebral cortex) by slowing degradation of acetylcholine released in cholinergic neurons; does not alter underlying dementia
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USES: Mild to severe dementia with Alzheimer’s disease
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Extracted information for donepezil only.
CONTRAINDICATIONS: Hyper- sensitivity to this product or piperidine derivatives Precautions: Pregnancy, breastfeeding, children, sick sinus syndrome, history of ulcers, GI bleeding, hepatic disease, bladder obstruction, asthma, seizures, COPD, abrupt discontinuation, AV block, GI obstruction, Parkinson’s disease, surgery
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SIDE EFFECTS CNS: Dizziness, insomnia, headache, fatigue, abnormal dreams, syncope, sei- zures, drowsiness, agitation, depression, confusion, hallucinations CV: Atrial fibrillation, hypo/hypertension GI: Nausea, vomiting, anorexia, diar- rhea, abdominal pain, weight gain GU: Urinary frequency INTEG: Rash, flushing, diaphoresis, bruising MS: Cramps, arthritis, arthralgia, back pain
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INTERACTIONS Increase: donepezil effects—CYP2D6, CYP3A4 inhibitors Increase: synergistic effect—succinyl- choline, cholinesterase inhibitors, cho- linergic agonists Increase: GI bleeding—NSAIDs Decrease: donepezil effects—CYP2D6, CYP3A4 inducers Decrease: action of anticholinergics Increase: QT prolongation—dofetilide, dronedarone, grepafloxacin, mesorida- zine, pimozide, probucol, sparfloxacin, ziprasidone; do not use concurrently Decrease: donepezil effect—carBAMaze- pine, dexamethasone, phenytoin, PHENo- barbital, rifAMPin Drug/Herb Decrease: donepezil—St. John’s wort Drug/Lab Increase: CK
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Extracted information for donepezil only.
DOSAGE AND ROUTES • Adult: PO 5 mg/day at bedtime; may in- crease to 10 mg/day after 4-6 wk, may in- crease to 23 mg/day after 3 mo of 10 mg/day (moderate to severe)
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Available forms: Tablets 5, 10, 23, mg; tablets ODT 5, 10 mg
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Administer: • Give between meals, may give with meals for GI symptoms • Allow ODT to dissolve on tongue, then drink water • Do not chew, crush, break D
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Extracted information for donepezil only.
Assess: • Alzheimer’s disease: ADLs, mem- ory, language, confusion baseline and during treatment • B/P: hypo/hypertension, heart rate, ECG, QT • Mental status: affect, mood, behav- ioral changes, depression, complete neu- rologic status • GI status: nausea, vomiting, anorexia, diarrhea; monitor weight, active/occult GI bleeding • GU status: urinary frequency, inconti- nence, I&O • Beers: avoid use in older adults; in- creases risk of hypotension/bradycardia • Pregnancy/breastfeeding: no well- controlled studies; use only if benefit outweighs fetal risk; avoid breastfeeding, excretion is unknown
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Evaluate: • Therapeutic response: decrease in confusion; improved mood, memory
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report side effects: twitching, nau- sea, vomiting, sweating, dizziness; indi- cates cholinergic crisis or overdose • That continuing follow-up will be needed • To use product exactly as prescribed, not to use with other products unless approved by prescriber • To notify prescriber of nausea, vomit- ing, diarrhea (dose increase or begin- ning treatment), or rash • Not to increase or abruptly decrease dose; serious side effects may result • That product is not a cure, relieves symptoms • To report if pregnancy is planned or suspected; to avoid breastfeeding HIGH ALERT
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Extracted information for donepezil only.
PHARMACOKINETICS Well absorbed PO; metabolized by CYP2D6, CYP3A4; half-life 10-hr single dose, 70-hr multiple doses; protein bind- ing 96%
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Filter the extracted dose blocks for this individual drug.
• Adult: PO 5 mg/day at bedtime; may in- crease to 10 mg/day after 4-6 wk, may in- crease to 23 mg/day after 3 mo of 10 mg/day (moderate to severe)
Candidate age grouping · source page 417