Dr. Saltiel received his Pharm.D. from the University of California, San Francisco, in 1980, following undergraduate work at UCLA. At UCSF, he was the recipient of the Outstanding Service Award and the Bowl of Hygeia Award. He completed a residency in clinical pharmacy practice at the University of Illinois, in Chicago.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Donepezil is an oral medication used to treat
Alzheimer's disease. It belongs to a class of drugs called cholinesterase
inhibitors that also includes tacrine (Cognex). Scientists believe that
Alzheimer's disease may result from a deficiency in chemicals
(neurotransmitters) used by nerves in the brain to communicate with one another.
Donepezil inhibits acetylcholinesterase, an enzyme responsible for the
destruction of one neurotransmitter, acetylcholine. This leads to increased
concentrations of acetylcholine in the brain, and the increased concentrations
are believed to be responsible for the improvement seen during treatment with
donepezil. Donepezil improves the symptoms but does not slow the progression of
Alzheimer's disease. Donepezil was approved by the FDA in 1996.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 5, 10 and 23 mg. Tablets (orally disintegrating
tablets): 5 and 10 mg.
STORAGE: Tablets should be stored at room temperature, 15-30 C (59-86 F).
PRESCRIBED FOR: Donepezil is used for the treatment of mild, moderate, or
severe dementia associated with Alzheimer's disease.
DOSING: Donepezil is generally taken once daily at night prior to retiring.
Its absorption is not affected by food so that it may be taken with or without
food. Mild to moderate disease is treated with 5 or 10 mg once daily. Moderate
to severe Alzheimer's disease is treated with 10 or 23 mg daily.
DRUG INTERACTIONS: Drugs with anti-cholinergic properties that can cross into
the brain, such as atropine, benztropine (Cogentin), and trihexyphenidyl (Artane)
counteract the effects of donepezil and should be avoided during therapy with
donepezil.
Donepezil is metabolized (eliminated) by enzymes in the liver. The rate of
metabolism of donepezil may be increased by medications that increase the
amounts of these enzymes, such as carbamazepine (Tegretol), dexamethasone (Decadron),
phenobarbital, phenytoin (Dilantin), and rifampin (Rifadin). By increasing
elimination, these drugs may reduce the effects of donepezil.
Ketoconazole (Nizoral) has been shown to block the enzymes in the liver that
metabolize donepezil. Therefore, concurrent use of ketoconazole and donepezil
may result in increased concentrations of donepezil in the body and possibly
lead to donepezil side effects. Quinidine (Quinidex, Quinaglute) also has been
shown to inhibit the enzymes that metabolize donepezil and may cause donepezil
side effects.
PREGNANCY: It is not known whether donepezil is harmful to the fetus. Safe
use during pregnancy has not been established.
NURSING MOTHERS: It is not known whether the donepezil is secreted into
breast milk or if breastfeeding while taking donepezil is safe for the nursing
infant.
SIDE EFFECTS: The most frequently reported side effects associated with
donepezil include headache, generalized pain, fatigue, dizziness, nausea,
vomiting, diarrhea, loss of appetite, weight loss, muscle cramping, joint pain,
insomnia, and increased frequency of urination.
Seizures, fainting,
abnormal
heart beats, and stomach ulcers also may occur. Tacrine (Cognex), another
anticholinesterase medication used in the treatment of Alzheimer's disease, is
associated with liver toxicity. Donepezil does not appear to be associated with
liver toxicity.
Parkinson's disease is a slowly progressive neurologic disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Parkinson's disease is the second most common neurodegenerative disorder and
the most common movement disorder. It is characterized by progressive loss of
muscle control, which leads to trembling of the limbs and head while at rest,
stiffness, slowness, and impaired balance. As symptoms worsen, it may become
difficult to walk, talk, and complete simple tasks.
The progression of Parkinson's disease and the degree of impairment vary from
individual to individual. Many people with Parkinson's disease live long
productive lives, whereas others become disabled much more quickly. Premature
death is usually due to complications such as falling-related injuries or
pneumonia.
In the United States, about 1 million people are affected by Parkinson's
disease and worldwide about 5 million. Most individuals who develop Parkinson's
disease are 60 years of age or older. Parkinson's disease occurs in
approximately 1% of i...
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