Aricept

Aricept (donepezil hydrochloride) is a prescription medication specifically formulated for the treatment of dementia associated with Alzheimer’s disease. As a centrally acting reversible acetylcholinesterase inhibitor, it works by increasing the concentration of acetylcholine in the brain, a neurotransmitter critical for memory, learning, and cognitive processing. This medication is indicated for mild, moderate, and severe stages of Alzheimer’s, offering a well-established pharmacological approach to symptom management. Clinical evidence supports its role in slowing cognitive decline and improving global function, making it a cornerstone in the therapeutic strategy for this progressive neurodegenerative disorder.

Features

• Active ingredient: Donepezil hydrochloride
• Available in 5 mg and 10 mg film-coated tablets
• Once-daily oral dosing regimen
• FDA-approved for all stages of Alzheimer’s disease
• Mechanism: Selective inhibition of acetylcholinesterase
• Bioavailability: Approximately 100% with linear pharmacokinetics
• Half-life: Approximately 70 hours, permitting steady-state concentration
• Metabolism: Hepatic, primarily via CYP2D6 and CYP3A4 isoenzymes
• Excretion: Urinary and fecal elimination

Benefits

• Slows the progression of cognitive decline in Alzheimer’s patients
• May improve or stabilize memory, orientation, and reasoning abilities
• Enhances functional capacity in activities of daily living
• Can reduce behavioral symptoms such as apathy and agitation
• Supports caregiver burden by potentially delaying institutionalization
• Provides a predictable pharmacokinetic profile with once-daily dosing

Common use

Aricept is primarily prescribed for the symptomatic treatment of dementia of the Alzheimer’s type. It is used across the disease spectrum—from mild to severe stages—to address core cognitive deficits including memory impairment, disorientation, and impaired judgment. In clinical practice, it is often initiated early following diagnosis to maximize potential benefits in slowing disease progression. Some off-label uses may include other forms of dementia, though evidence is less robust, and such use should be carefully evaluated by a neurologist or geriatric specialist.

Dosage and direction

The recommended starting dose for Aricept is 5 mg administered orally once daily, preferably at bedtime. After 4–6 weeks, and based on clinical assessment and tolerability, the dose may be increased to 10 mg once daily. Dosage adjustment is not typically required for elderly patients or those with renal or mild to moderate hepatic impairment. For severe hepatic impairment, caution is advised. Tablets should be swallowed whole with water, with or without food. Do not crush or split tablets.

Precautions

Patients with a history of cardiac conduction abnormalities, such as sick sinus syndrome or supraventricular conduction defects, should be monitored closely due to the potential for bradycardia. Use with caution in those with a history of peptic ulcer disease or those taking NSAIDs, as cholinomimetics may increase gastric acid secretion. Pulmonary conditions such as asthma or COPD warrant careful observation due to possible bronchoconstriction. Seizure disorders may be exacerbated. Regular ophthalmologic exams are recommended due to the theoretical risk of retinal detachment.

Contraindications

Aricept is contraindicated in patients with known hypersensitivity to donepezil hydrochloride, piperidine derivatives, or any excipients in the formulation. It should not be used in individuals with severe liver impairment (Child-Pugh Class C). Concomitant use with other cholinomimetics or anticholinesterase agents is contraindicated. Patients with a history of serious allergic reactions to similar compounds should avoid this medication.

Possible side effect

Common adverse reactions (≥5%) include nausea, diarrhea, insomnia, vomiting, muscle cramps, fatigue, and anorexia. Less frequently, bradycardia, syncope, headache, dizziness, agitation, and urinary incontinence may occur. Rare but serious side effects include gastrointestinal bleeding, seizures, extrapyramidal symptoms, and neuroleptic malignant syndrome. QT prolongation and rash have been reported. Most side effects are dose-dependent and often transient.

Drug interaction

Strong CYP3A4 inhibitors (e.g., ketoconazole) and CYP2D6 inhibitors (e.g., quinidine) may increase donepezil concentrations. Cholinergic agonists (e.g., bethanechol) may potentiate effects. Anticholinergic agents (e.g., oxybutynin, tolterodine) may antagonize therapeutic benefits. Concomitant use with beta-blockers, digoxin, or calcium channel blockers may increase the risk of bradycardia. NSAIDs may elevate the risk of gastrointestinal bleeding. Use with succinylcholine-type muscle relaxants may prolong neuromuscular blockade.

Missed dose

If a dose is missed, it should be taken as soon as remembered, unless it is nearly time for the next scheduled dose. In that case, skip the missed dose and resume the usual dosing schedule. Do not double the dose to make up for a missed one. Consistency in dosing is important to maintain stable plasma concentrations.

Overdose

Symptoms of overdose may include severe nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, muscle weakness, and convulsions. In cases of significant overdose, syncope or lethal cardiorespiratory collapse may occur. Management includes general supportive measures, intravenous atropine sulfate titrated to effect, and cardiac monitoring. Activated charcoal may be administered if ingestion was recent.

Storage

Store at room temperature (20–25°C or 68–77°F), in a dry place, protected from light and moisture. Keep the bottle tightly closed and out of reach of children and pets. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication regimen. Individual patient responses may vary.

Reviews

Clinical trials and post-marketing surveillance have consistently demonstrated that Aricept provides modest but statistically significant benefits in cognitive and global function measures in Alzheimer’s patients. Many clinicians report observable stabilization in decline over 6–12 months of treatment. Patient and caregiver testimonials often note improved engagement and daily functioning, though gastrointestinal side effects are a common reason for discontinuation. Overall, it remains a first-line option in evidence-based guidelines.