Donepezil: A good first step in the treatment of Alzheimer's disease

As the average lifespan grows increasingly longer, the incidence of Alzheimer's disease (AD) and similar dementias may be expected to increase by as much as three-fold over the next 40 years. The first pharmcotherapeutic agent approved for use in treating AD, tacrine, is associated with liver toxicity and gastrointestinal side effects as well as compliance problems due to q.i.d. Donepezil (Aricept®), the only cholinesterase inhibitor that has been approved for this indication in both the U.S. and Canada, has shown symptomatic improvement in 75-80% of AD patients in a once-daily treatment regimen. Efficacy and safety of donepezil have been demonstrated in both controlled clinical trials and long-term, open-label investigations in mild- to moderate-stage AD, with a low incidence of adverse effects. Treatment is initiated with donepezil 5 mg/day for 4-6 weeks, followed by upward titration to 10 mg daily if tolerability permits. Studies suggest that the loss of function in activities of daily living is considerably slower with donepezil treatment, with the potential for significant savings to society in the costs associated with AD patient care.