Aricept: Enhance Cognitive Function in Alzheimer's Disease
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Synonyms
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Aricept (donepezil hydrochloride) is a prescription medication specifically indicated for the treatment of dementia of the Alzheimer’s type. It belongs to the pharmacological class of acetylcholinesterase inhibitors and functions by increasing the levels of acetylcholine, a crucial neurotransmitter involved in memory, attention, reasoning, and language. This medication is approved for use in mild, moderate, and severe stages of Alzheimer’s disease, offering a well-established therapeutic option to manage cognitive symptoms, support functional abilities, and potentially slow symptom progression. Clinical evidence supports its role in stabilizing or improving cognitive performance and global functioning in a significant proportion of patients.
Features
- Active ingredient: Donepezil hydrochloride
- Available in 5 mg and 10 mg oral tablets, and a 23 mg extended-release tablet formulation
- Also available as an orally disintegrating tablet for ease of administration
- Selective, reversible inhibitor of acetylcholinesterase
- Once-daily dosing regimen for patient convenience and adherence
- FDA-approved for all stages of Alzheimer’s disease dementia
Benefits
- Improves cognition, including memory, attention, and orientation
- Enhances ability to perform activities of daily living
- May help slow the progression of cognitive decline in Alzheimer’s disease
- Can support maintenance of patient independence for a longer period
- Demonstrates a favorable safety profile with extensive clinical experience
- Provides measurable benefits in global functioning as assessed by clinicians
Common use
Aricept is primarily prescribed for the treatment of dementia associated with Alzheimer’s disease across all severity stages—mild, moderate, and severe. It is used to address core cognitive symptoms including memory impairment, disorientation, and problems with reasoning and judgment. The medication may also provide benefits in supporting functional abilities such as personal care, household tasks, and social interaction. Some clinicians may consider its use in other forms of dementia, though this constitutes off-label use not supported by the FDA approval.
Dosage and direction
The recommended starting dosage for Aricept is 5 mg administered once daily, preferably at bedtime. After 4-6 weeks of treatment, the dosage may be increased to 10 mg once daily if well tolerated. For patients with moderate to severe Alzheimer’s disease who have been on 10 mg daily for at least three months, the 23 mg extended-release tablet may be considered. Tablets should be swallowed whole with water, without crushing, splitting, or chewing. The orally disintegrating tablet formulation should be placed on the tongue and allowed to dissolve before swallowing with or without water. Dosage adjustments may be necessary for patients with hepatic impairment or those taking certain concomitant medications.
Precautions
Patients should be monitored for gastrointestinal effects including nausea, vomiting, diarrhea, and weight loss. Those with cardiac conduction abnormalities, particularly sick sinus syndrome or supraventricular conduction defects, require careful monitoring due to potential cholinergic effects on heart rate. Caution is advised in patients with asthma, chronic obstructive pulmonary disease, or other pulmonary conditions due to increased bronchial secretions. Patients with a history of peptic ulcer disease or those taking NSAIDs concurrently should be monitored for gastrointestinal bleeding. Aricept may cause bladder outflow obstruction and should be used cautiously in patients with urinary retention. The medication may increase the risk of seizures in susceptible individuals.
Contraindications
Aricept is contraindicated in patients with known hypersensitivity to donepezil hydrochloride, piperidine derivatives, or any components of the formulation. It should not be administered to patients with demonstrated allergic reactions including skin rash, urticaria, or anaphylaxis to the drug. The 23 mg formulation is contraindicated in patients who have not first been stabilized on Aricept 10 mg daily. Concomitant use with other cholinomimetic drugs or cholinesterase inhibitors is not recommended due to additive pharmacological effects.
Possible side effects
The most common adverse reactions are cholinergic in nature and include nausea (11-19%), diarrhea (8-15%), insomnia (9-14%), vomiting (5-8%), muscle cramps (5-8%), fatigue (5-8%), and anorexia (4-7%). Less frequently reported side effects include dizziness, headache, syncope, bradycardia, gastrointestinal bleeding, and urinary incontinence. The 23 mg formulation demonstrates a higher incidence of gastrointestinal side effects compared to the 10 mg tablet. Most side effects are mild to moderate in severity and often diminish with continued treatment. Serious but rare adverse events include seizures, extrapyramidal symptoms, and neuroleptic malignant syndrome.
Drug interaction
Aricept may potentiate the effects of succinylcholine-type muscle relaxants during anesthesia. Concurrent use with anticholinergic medications may reduce the efficacy of both drugs. Drugs that inhibit CYP450 3A4 and 2D6 enzymes (such as ketoconazole, quinidine) may increase donepezil concentrations. Conversely, inducters of these enzymes (such as rifampin, carbamazepine, phenytoin) may decrease donepezil levels. Beta-blockers may enhance the bradycardic effects of donepezil. NSAIDs may increase the risk of gastrointestinal bleeding when used concomitantly. Cholinomimetic agents and other cholinesterase inhibitors should be avoided due to additive effects.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not take double or extra doses to make up for a missed dose. Consistent daily administration is important for maintaining therapeutic drug levels. If multiple doses are missed, consultation with a healthcare provider is recommended before resuming treatment, as dosage adjustment may be necessary.
Overdose
Symptoms of overdose may include severe nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, syncope, and convulsions. Increasing muscle weakness may occur and can result in death if respiratory muscles are involved. A paradoxical response characterized by hypertension and hallucinations has also been reported. Treatment should be symptomatic and supportive, with general measures taken to ensure adequate airway protection. Intravenous atropine sulfate titrated to effect is recommended as an antidote, with initial doses of 1.0 to 2.0 mg IV, with subsequent dosing based on clinical response.
Storage
Aricept tablets should be stored at controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). The medication should be kept in its original container, tightly closed, and protected from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. The orally disintegrating tablets should be kept in the blister package until immediately before use to maintain stability.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Aricept is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to treatment may vary, and not all patients will experience the same benefits or side effects. Patients should consult their healthcare provider for personalized medical advice, including proper diagnosis, treatment options, and monitoring. Never disregard professional medical advice or delay seeking it because of information contained in this document.
Reviews
Clinical studies involving over 10,000 patients have demonstrated that Aricept provides statistically significant improvements in cognitive function, activities of daily living, and global clinical state compared to placebo. In a 24-week randomized controlled trial, 63% of patients on donepezil 10 mg showed improvement or no decline in global function compared to 42% on placebo. Long-term studies suggest that treatment may delay nursing home placement by approximately 21 months. Many clinicians report observable benefits in patient engagement, communication, and functional abilities. However, individual responses vary, and some patients may not respond significantly to therapy. The medication is generally well-tolerated, with most side effects diminishing over time.