Elzer

Indications

Donepezil Hydrochloride is used to treat the symptoms of mild, moderate and severe dementia caused by Alzheimer's disease. It can help memory, thinking, and the ability to carry out daily activities for a time. It does not cure Alzheimer's disease or stop it from progressing.

How It Works

In Alzheimer's disease, levels of acetylcholine, a brain chemical needed for memory and learning, fall. Donepezil is a cholinesterase inhibitor: it blocks the enzyme that breaks down acetylcholine, so more of it stays available in the brain.

Dosage and Administration

Adults: start with 5 mg once a day, taken in the evening just before bed. After 4 to 6 weeks the doctor may increase the dose to 10 mg once a day. In severe dementia, specialists sometimes use a higher dose, only as prescribed.

Take with or without food. A carer should help make sure doses are taken regularly. The doctor will review whether the medicine is still helping.

If treatment is stopped for several days, ask the doctor before restarting, as a lower dose may be needed. Children: not for use.

Interactions

• Medicines with anticholinergic effects (such as Amitriptyline, Oxybutynin and some antihistamines) can work against Donepezil.
• Beta blockers (such as Atenolol), Digoxin and some calcium channel blockers can add to slowing of the heart.
• Medicines that affect heart rhythm (such as some antipsychotics, antibiotics like Clarithromycin, and antiarrhythmics) increase the risk of rhythm problems.
• Ketoconazole and Itraconazole may raise Donepezil levels; Rifampicin, Carbamazepine and Phenytoin may lower them.
• Painkillers such as Ibuprofen or Diclofenac (NSAIDs) increase the risk of stomach ulcers.
• Tell the anaesthetist you take Donepezil before any operation, as it affects some muscle relaxants.

Contraindications

• Allergy to Donepezil or to piperidine-type medicines

Side Effects

Common: nausea, vomiting, diarrhoea, loss of appetite, muscle cramps, tiredness, trouble sleeping, vivid dreams, headache and dizziness. These are often mild and settle over a few weeks. Taking the dose at bedtime may help.

Get medical help at once for fainting or near fainting, a very slow or irregular heartbeat, black or bloody stools or vomiting blood (possible stomach bleeding), fits, difficulty passing urine, fever with muscle stiffness and confusion, or unexplained muscle pain with dark urine.

Pregnancy and Lactation

Donepezil is not normally used in women who could become pregnant. If pregnancy occurs, consult the doctor. It is not known whether it passes into breast milk; it should not be used while breastfeeding.

Precautions and Warnings

• Take extra care with heart rhythm problems, a slow heart rate or fainting spells.
• Take extra care with a history of stomach ulcers, asthma or chronic lung disease, fits, or difficulty passing urine.
• Dizziness and tiredness are common at the start; check with the doctor before driving.
• Weight loss can happen; the doctor may check weight regularly.

Overdose

Overdose can cause severe nausea, vomiting, drooling, sweating, a slow heartbeat, low blood pressure, breathing difficulty, muscle weakness and fits. Go to hospital at once. Atropine may be used in hospital.

Therapeutic Class

Anti-dementia medicine (cholinesterase inhibitor).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.