III. Indications

  1. Mild to Moderate Dementia (Folstein MMSE: 10-26)

IV. Adverse Effects

  1. See Acetylcholinesterase Inhibitor
  2. No hepatotoxicity
  3. Syncope and Torsades de Pointes (have been reported for Aricept, but not other Acetylcholinesterase Inhibitors)

V. Dosing

  1. Start at 5 mg orally at bedtime
  2. Increase to 10 mg orally at bedtime after 4-6 weeks
  3. Increase to 23 mg orally at bedtime after 3 weeks at 10 mg dose

VI. Advantages

  1. Generic Aricept is the least expensive of the Cholinesterase Inhibitors ($11 for 30 tablets in 2017)

VII. Efficacy

  1. See Acetylcholinesterase Inhibitor
  2. As effective as Cognex (without the hepatotoxicity risk)
  3. Mini-Mental Status Exam changes
    1. Reduces decline by 3 points in 6 months
    2. Patient reverts to prior decline with Drug Withdrawal
  4. May be preferred over Galantamine
    1. Appears more effective than Galantamine
    2. Better tolerated than Galantamine
    3. Lanctot (2003) CMAJ 169:557-64 [PubMed]
  5. Long-term use of Donepezil has minimal to no effect
    1. Does not prevent Nursing Home placement
    2. Minimally improves cognition
    3. Does not protect against longterm functional decline
    4. Courtney (2004) Lancet 363:2105-15 [PubMed]

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Cost: Medications

aricept (on 11/23/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
ARICEPT 10 MG TABLET Generic $0.05 each
donepezil (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
DONEPEZIL HCL 10 MG TABLET Generic $0.05 each
DONEPEZIL HCL 23 MG TABLET Generic $2.06 each
DONEPEZIL HCL 5 MG TABLET Generic $0.06 each
DONEPEZIL HCL ODT 10 MG TABLET Generic $0.25 each
DONEPEZIL HCL ODT 5 MG TABLET Generic $0.21 each

Ontology: Aricept (C0527315)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C076946
English Aricept, aricept, Eisai brand of donepezil hydrochloride, Pfizer brand of donepezil hydrochloride

Ontology: donepezil (C0527316)

Definition (NCI) The hydrochloride salt of a piperidine derivative with neurocognitive-enhancing activity. Donepezil reversibly inhibits acetylcholinesterase, thereby blocking the hydrolysis of the neurotransmitter acetylcholine and, consequently, increasing its activity. This agent may improve neurocognitive function in Alzheimer's disease, reduce sedation associated with opioid treatment of cancer pain, and improve neurocognitive function in patients who have received radiation therapy for primary brain tumors or brain metastases.
Definition (NCI_NCI-GLOSS) A drug that is used to treat Alzheimer disease and is being studied in the treatment of side effects caused by radiation therapy to the brain. It is a type of cholinesterase inhibitor.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C076946
SnomedCT 108497001, 386855006
LNC LP66954-6, MTHU028051
English donepezil, donepezil [Chemical/Ingredient], DONEPEZIL, Donepezil (product), Donepezil (substance), Donepezil, DONEP
Spanish donepezil, donepecil (producto), donepecil, donepezilo (sustancia), donepezilo, donepezilo (producto), donepezil (sustancia), donepecil (sustancia)