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Donepezil and Keppra
Another question: Do PWD ever stop taking Donepezil (Aricept) ? What are the downsides of taking this drug? Does this drug just prolong the inevitable?
I am sad about prescribing more drugs. Does Donepezil help him anymore? Would like to hear about any experiences with going off Donepezil.
Donepezil tends to be tolerated and is not terribly expensive. Everyone reacts to drugs differently so YMMV. Some people report a decline after thinking the Aricept is no longer helping and stopping it, so we have left it alone and my mom continues to take it now in the final stages of Alz. At this point we don't really know if it's helping but don't want to find out.
I found these videos by Teepa Snow explain the drug very well. I don't know why it's in two parts, but it's all I can find. Each of these links is part of her explanation and they are just a few minutes. The first explains what is wrong with the brain chemicals and the second explains what this class of drugs does to help at various stages of dementia. If your LO does not have side effects I personally would use it.
Not trying to argue, but when my dad was diagnosed (about 2008), and before Aricept went generic, the manufacturer itself stated the drug was thought to be effective for about 3-4 years.
This site really amazes me. They are so ready to delete when one person’s
say something wrong like that is so critical. But should people inform others
about the wrong medication information they consider that acceptable. When it
really dangerous the just don’t care. That goes for the moderators and Alzheimers
Association. You wonder why these folks even exist if they cannot help with
issues related to dementia drugs.
Anyone can Google donepezil for themselves and find that the FDA has approved it to be used now in all stages of dementia.
We on this board do not have to debate this when the facts are out there.
Michael: it is not the responsibility of the AA to verify the accuracy of information posted on this site. That responsibility lies with each individual member. In the internet age, accurate information is not difficult to come by.
Sjplegacy. I see this is your first post. Welcome.
Marta can you please send me a link to that. I have fought for many
years to bring this change as most were
not aware of this. I even fought with the FDA and others. If they have changed
what they said that is great and would like to see it. Thanks You made my day
if this is true now.
Lane do you read this and is it true? I think you know the time I spent
on this in the past, If not I can share the emails with you.
Thank you for asking, Michael. This is one of the thorniest debates around. Aricept (donepezil) has been approved for all stages of Alzheimer's disease, but it likely only slows down the progression of the disease (at least in terms of cognition) for awhile during the early to middle stages.
Thank you for sharing all this information, Michael. I am just posting this to show how different people's experience with Aricept can be. I cannot explain the reasons behind these differences.
This is just for informational purposes:
Cholinesterase inhibitors and memantine do not change the progression of AD. In the 1-year AD2000 clinical trial, donepezil demonstrated slight improvements in cognition and function, but failed to delay institutionalization, reduce caregiver burden, or lower costs.54 Results of a recent Cochrane review of donepezil trials showed a mean reduction of -2.7 points on the Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog, range 0-70), but no benefit for behavioral symptoms, QOL [qulaity of life], or total healthcare resource utilization.55 This falls below the 4-point difference on the ADAS-Cog [Alzheimer's Disease Assessement Score-cognitive] that is generally recognized as clinically meaningful.56 AEs [adverse effects] with donepezil were dose related. In particular, donepezil 23 mg/day did not improve cognitive function more than 10 mg/day, but increased the risk of AEs and premature treatment discontinuation.55 In another recent Cochrane review, memantine demonstrated a small clinical benefit versus placebo in patients with moderate to severe AD, but had no benefit in patients with mild AD.57
In a systematic review that excluded clinical trials with a high risk of bias, cholinesterase inhibitors and memantine slightly reduced short-term cognitive decline.8 It was unclear if these effects are clinically meaningful. Cholinesterase inhibitors had a small mean improvement in cognition with a median standardized mean difference (SMD) of 0.30 (range, 0.24, 0.52). For function, effects ranged from no difference to a small improvement, with a median SMD of 0.19 (range, -0.10-0.22). Memantine did not demonstrate any benefit in patients with mild to moderate CATD [Alzheimer's type disease]. In moderate to severe CATD, insufficient to low-strength evidence inconsistently suggested that adding memantine to a cholinesterase inhibitor improved cognition, but not function.8
As part of the Choose Wisely initiative, the American Geriatrics Society recommends against prescribing cholinesterase inhibitors unless cognitive benefits and gastrointestinal AEs are monitored.58 A cholinesterase inhibitor should be stopped after 12 weeks if improvements are not observed on practical treatment outcomes reflecting stabilization of cognition that can be easily assessed. Patients and caregivers should be counseled about AEs before beginning a trial of cholinesterase inhibitors. Deprescribing of cholinesterase inhibitors has been linked to a reduction in falls and fractures, but not an increase in the risk of aggressive behaviors and antipsychotic prescribing in nursing home residents with severe dementia.59,60 Cholinesterase inhibitor AEs are often unrecognized and lead to a “prescribing cascade” that contributes to a treatment burden in patients with AD. For example, observational studies have found that patients receiving a cholinesterase inhibitor had an increased risk of receiving an anticholinergic drug to manage urinary incontinence, which is likely caused or exacerbated by the cholinesterase inhibitor.61,62
The article goes on to discuss some of the drugs currently being studied for the treatment of Alzheimer's disease.