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Alzheimer’s disease is taking center stage in our society as the number of older people grows. Today we talk to you about one of the drugs that are most frequently used to try to improve or preserve the quality of life of patients.
Donepezil is a drug used for the symptomatic treatment of Alzheimer’s disease.. It has been approved in Spain with that indication since 1998. It is also marketed as Aricept or Yasnal.
We are not talking about a curative medicine. Alzheimer’s, until now, is a neurodegenerative and irreversible disease. It has no cure. Donepezil is an aid in the treatment of the symptoms of this disease. Its objective is to improve the quality of life of patients.
Mechanism of action
Donepezil is a specific and reversible inhibitor of acetylcholinesterone. This enzyme is responsible for breaking down acetylcholine. Therefore, its inhibition increases the levels of this neurotransmitter in different regions of the brain. Or, rather, it slows down the process of its destruction.
Acetylcholine affects memory and other cognitive functions. Precisely, in Alzheimer’s disease, a decrease in cholinergic activity of up to 95% has been discovered. Hence the usefulness of these acetylcholinesterase inhibitors in the treatment of dementia. Its mission is to delay the symptoms of Alzheimer’s.
Acetylcholine is the most abundant neurotransmitter in our body. It is present in the central nervous system, just as it is also present in the peripheral nervous system. What does this mean? Increasing acetylcholine levels in the brain improves dementia. But the increase at the peripheral level causes side effects cholinergic type.
Alzheimer disease
Alzheimer’s is a neurodegenerative disease. It is a neurological disorder that causes the massive destruction of nerve cells in the brain. These cells are cholinergic neurons. Different areas of the brain atrophy.
This destruction process occurs due to the development of amyloid plaques. These plaques are deposits that form around brain cells. They are made of a protein called beta-amyloid. In the case of Alzheimer’s, this protein is defective and neuronal death is triggered.
One of the first symptoms is memory deficit. As the disease progresses, cognitive and behavioral functions deteriorate, leading to dementia. and, finally, to death.
Use of donepezil in Alzheimer’s disease
Donepezil is indicated for the symptomatic treatment of Alzheimer’s disease. mild to moderately severe.
Various studies demonstrate its effectiveness in improving cognitive functions. And also in the global function of Alzheimer’s patients.
Treatment should always be started and supervised by a specialist. It is administered orally in a single daily dose. It should be administered at night, before going to bed.
First, you start with a dose of 5 mg per day, for at least a month. Then, after clinical evaluation, increasing to 10 mg per day may be considered. Also in a single dose. The higher the dose, the greater the therapeutic effect, but the side effects will also increase in number and intensity.
Treatment with Donepezil can be continued as long as there is a therapeutic benefit.. A clinical evaluation should be performed periodically. And when this is not positive, suspension of treatment should be considered.
According to some studies, the Donepezil has demonstrated the same clinical efficacy as other acetylcholinesterase inhibitors. Other drugs in this group that are also used are rivastigmine and galantamine. And, on the other hand, with a different mechanism of action, memantine. Although donepezil remains the most prescribed active ingredient.
Also combination therapy is being studied of several of these drugs. It could be another alternative for the treatment of dementia associated with Alzheimer’s disease.
The risk of adverse effects increases if we combine two acetylcholinesterase inhibitors. However, the combination of donepezil and memantine, for example, seems to give better results. However, further research is necessary.
Side effects
The Most important side effects in donepezil treatment are:
Diarrhea.Nausea..Anorexia.Fatigue.Insomnia.Muscle cramps.Headache.
Sometimes some of these side effects cause treatment suspension. It frequently happens with gastrointestinal adverse reactions. For example, nausea and diarrhea.
In general, side effects are dose dependent. Donepezil is well tolerated at doses of 5 mg daily, but presents more problems at the 10 mg dose. That’s why, It is important to frequently reevaluate its effectiveness and adjust the most appropriate dose for each patient and moment..
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All cited sources were reviewed in depth by our team to ensure their quality, reliability, validity and validity. The bibliography in this article was considered reliable and of academic or scientific accuracy.
Spanish Agency for Medicines and Health Products (2015). Data sheet. Aricept. Available at: https://cima.aemps.es/cima/dochtml/ft/61869/FT_61869.htmlRomano, M., Nissen, MD, Del Huerto, N., & Parquet, C. (2007). Alzheimer disease. Postgraduate Journal of the Medicine Chair, 75, 9-12.Portela Romero, M., Pombo Romero, J., Bugarín González, R., Tasende Souto, M., & Represa Veiga, S. (2005). Use of acetylcholinesterase inhibitors and memantine for the treatment of Alzheimer’s dementia. Spanish Journal of Public Health, 79(6), 665-672.Rogers, SL, Doody, RS, Mohs, RC, & Friedhoff, LT (1998). Donepezil improves cognition and global function in Alzheimer disease: a 15-week, double-blind, placebo-controlled study. Archives of internal medicine, 158(9), 1021-1031.
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