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Doctors' Answers to "Frequently Asked Questions" - Aricept

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Efficacy Of Aricept [posted 1/5/99]
Question:I am most interested in recent/current information regarding the efficacy of Aricept. Specifically, I have heard that it is of no real effectiveness after approximately 6 months of use. Is the current trend among Geriatricians to prescribe the drug for Alzheimer’s patients? Is it prescribed for an indefinite time period or for a limited time? Does it depend on the stage of the disease?

Answer:We usually provide it and measure it's effectiveness often through use of an Mini Mental Status Exam (MMSE). However, the natural history of Alzheimer's is a progressive decline. We currently think that the decline in effectiveness reflects on the underlying disease, not the medication. I have patients who have had improvement for 1-2 years and other patients who decline/little effect in 3-6 months. I would check with the company concerning studies, Pfizer: 800-723-7529.

Is Aricept Only for Alzheimer's [posted 11/18/98]
Question:  Are there other uses for Aricept other than Alzheimers? My father is seeing a neurologist for a spasm (he describes it to be like an electric shock) like condition that he get along the top of his outer eyebrow. The doctor prescribed Aricept for this, but never mentioned Alzheimers. What else is Aricept prescribed for?

Answer:  Only use that is approved.

Aricept [posted 10/1/98]
Question: My dad has been diagnosed with dementia. The drug aricett has been prescribed by a specialist, what side effects are there, and what kind of results can be expected?

Answer:Aricept is a recent addition to the treatment of dementia. Although there is a long list of potential side effects, it generally has minimal problems. GI symptoms(nausea, cramps, diarrhea, etc) tend to predominate.

Aricept [posted 8/14/98]
Question: My father is 76 and has been struggling with varying degrees of short term memory loss for about 2 years. He is taking Vitamin B shots and regularly sees an Internist and Neurologist. It was suggested that he try the drug Aricept, but we have questions about this medication and its side effects. Any thoughts, suggestions or information you have would be helpful.

Answer: Aricept is a acetylcholinesterase inhibitor. It is used to treat patients with Alzheimer's Dementia. Some physicians will try it on patients prior to a clear case of Alzheimer's to test its effect since there are so few things one can treat memory loss with that help. Side effects include nausea, diarrhea, muscle cramps, weight gain, insomnia and depression. It is dosed at either 5 or 10 mg a day. It should be used with care when given concurrently with ketoconazole or quinidine. It is usually worth a try since the side effects are fairly minimal and self limited. However, I haven't seen a lot of success (like other drugs in this group).

Aricept [posted 8/14/98]
Question: I am trying to find out information regarding the drug Aricept?

Answer: Aricept is an inhibitor of acetylcholinesterase. Since Alzheimer's disease involves a deficiency in acetylcholine and cholinergic activity, this drug allows an increase in this level by inhibiting the enzyme responsible for breaking it down. Side effects include nausea, diarrhea, muscle cramps and insomnia.

Aricept [posted 8/11/98]
Question: My mother has been diagnosed for 1-1/2 years and the doctor has just prescribed Aricept 5 mg. He had no literature, but said it may be useful to stop or slow the most recent memory losses. I can't seem to find any information on this drug. Do you have any?

Answer: Happy to give you information, but you should consider another physician if they don't have the interest/energy/professional integrity to understand the drugs they are prescribing. From my perspective, that is the worst kind of physician. Aricept is a recently approved drug for use in Alzheimer's type Dementia. It has the brand name Donepezil hydrochloride. It is a reversible inhibitor of acetylcholinesterase which is the apparent mode of action in the brain. From my experience, about 20% - 30% of patients improve - especially in the earlier stages of the disease. Side effects include slowing of the heart rate (and is contraindicated in patients with sick sinus syndrome), should be watched closely if the patient has a history of ulcers (increases acid). Common side effects include nausea, diarrhea, urinary hesitancy, muscle cramps, fatigue and insomnia. Hypertension is also seen occasionally. It takes some time to achieve steady state and the dosage should not be increased to 10 mg until the patient has been on 5 mg for 6 weeks or so. I usually give mental status tests to have an accurate gauge to follow for improvement since it is somewhat expensive.

Aricept Side Effects [posted 8/4/98]
Question: I've noticed the clinical trials for aricept were for a period of 6 months. I have a patient who had a dramatic turn-around on aricept approximately 1 year ago who now presents with lethargy over the past 2 months. The patient also has some mild hand tremors. Are there any long term studies on aricept? Me and her attending physician are now questioning the aricept as all preliminary work up has been negative.

Answer: Stop the Aricept and see what happens. If it persists, I'd contact the company (easily done with your physician) and discuss the findings.

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