Post by norbert1 on Dec 14, 2007 21:21:16 GMT -5
Contained in this article-
- Basic Aricept information
- What is the difference between Aricept and Exelon
- Dosage and administration
- Combination treatment - Aricept and Namenda in Moderate to late stage.
- Should Aricept be stopped in late stage
----------------------------------------
- Basic Aricept information
The following is from the Mayo Clinic regarding medications for A.D. (Originally posted by pepprockk):
Although researchers are developing therapies designed to stop or possibly prevent the progression of Alzheimer's disease, no such therapy is available yet. Instead, current treatments focus on stabilizing the symptoms, improving well-being and easing caregiver burden.
One such treatment option is a class of drugs called cholinesterase (ko-lin-ES-tur-ays) inhibitors, which help improve cognitive function — memory, language, critical thinking, reading and writing. Ronald Petersen, M.D., a neurologist at Mayo Clinic, Rochester, Minn., says that although these drugs are useful, people should be cautious with their expectations. "Cholinesterase inhibitors are not cures," says Dr. Petersen, "but they can provide symptomatic help for some patients, which can improve their quality of life."
How they work
Many areas of the brain deteriorate as Alzheimer's disease progresses. As brain cells die, connections between the cells are destroyed, and symptoms — such as memory loss, confusion, and problems with thinking and reasoning — increase.
Cholinesterase inhibitors stabilize these symptoms by preventing the breakdown of acetylcholine, a chemical that carries impulses between brain cells. These impulses are important for attention, learning and memory. By preventing the breakdown of this chemical, these drugs help maintain the communication pathways between cells.
As the disease progresses and more cells die, however, the brain produces less acetylcholine. Therefore, these medications are most beneficial in the early to middle stages of the disease — generally 3 to 6 years after diagnosis — when levels of acetylcholine are still relatively high.
Several choices available
All cholinesterase inhibitors slow cognitive decline by preventing the breakdown of acetylcholine. But slight differences exist in how the drugs are prepared or how often they're taken.
The Food and Drug Administration (FDA) has approved the following drugs for the treatment of Alzheimer's:
• Donepezil (Aricept). The most commonly prescribed cholinesterase inhibitor is donepezil, which the FDA approved in 1996. In clinical trials, people with Alzheimer's who took donepezil did better on memory and reasoning assessments than did those who were given an inactive substance (placebo). Taken once a day, donepezil is available in tablet form and has a maximum daily dosage of 10 milligrams (mg).
• Galantamine (Reminyl). Galantamine — approved by the FDA in 2001 — is the newest cholinesterase inhibitor on the market. It improves memory and thinking skills for those with Alzheimer's and may reduce behavioral symptoms such as anxiety or aggression. During clinical trials, people usually experienced only mild side effects. Taken twice a day, galantamine is available in tablet form and has a maximum daily dosage of 24 mg.
• Rivastigmine (Exelon). Taken orally twice a day, rivastigmine was approved by the FDA in 2000. Higher doses of rivastigmine may be more effective than lower doses, but may also cause more gastrointestinal problems such as nausea or vomiting. Maximum daily dosage of rivastigmine, which comes in capsule or liquid form, is 12 mg.
Tacrine (Cognex) is another drug that's available. Taken four times a day, tacrine has been on the market since 1993. However, doctors rarely prescribe this drug because of serious side effects, including possible liver damage.
Side effects
In general, these medications cause only mild side effects. Gastrointestinal problems — such as nausea, vomiting or diarrhea — are the most common complaints. Other side effects may include:
• Stomach pain
• Loss of appetite
• Weight loss
• Muscle weakness
Cholinesterase inhibitors can also increase a person's risk of stomach ulcers. Use caution when combining these drugs with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen. When used in combination, the chances of developing stomach ulcers increases even more.
To minimize discomfort, your doctor may prescribe a low dose of the drug and increase it gradually over a period of several weeks. Taking medication with food may also help limit side effects.
What to expect
These drugs don't cure Alzheimer's, but they may slow the progression of the disease. Any beneficial effects — such as improved memory or thinking ability — are usually modest and temporary. And according to the Alzheimer's Association, about half of those who take cholinesterase inhibitors experience no improvement at all in their symptoms.
Furthermore, once the disease advances beyond the moderate stage, these drugs appear to be ineffective and cognitive decline resumes. Possible long-term effects of these medications aren't known, but studies are under way to observe them.
Modest but invaluable
Though modest, improvements in thinking and memory may be seen as invaluable because they can delay the need for caregiver assistance. For example, the medications may extend the period of time in which your loved one is able to bathe or groom without assistance. And they may also delay the need for nursing home care.
These drugs can address other behaviors as well. "Cholinesterase inhibitors may help with noncognitive behaviors such as depression and apathy," says Dr. Petersen. "And some individuals become more energized and interactive on these medications." Others may find these therapies useful in easing challenging behaviors such as aggression or anxiety.
----------------------------------------------------------------------------.
- What is the difference between Aricept and Exelon
Barbara asks, “what is the difference between Aricept and Exelon.
-----------
Exelon and Aricept (and Razadyne) are very similar meds and do exactly the same thing.
Aricept always had an advantage because it could be taken once a day, while exelon had to be taken twice a day. But exelon is now available in an extended release version, so it can be taken once a day also. In general, timed release formulations tend to be better because the levels in the blood are more steady and so there are fewer problems.
Generally, these drugs do exactly the same thing, but there are some differences, so that occasionally, one individual will do poorly on one and do well on another. But overall, and across a large number of patients, One is no better than the other. Or at least that is what the technical VP of the alzheimers association said in one presentation.
----------------
Additional information:
------
Alzheimer's Disease Medications Fact Sheet
www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm
Information Aricept, Exelon and Reminyl
www.alz.org/documents/national/FS_cholinesteraseinhibtors.pdf
www.alz.org/national/documents/topicsheet_treatments.pdf
Article = Dementia Drugs Demystified:
What to expect - and not expect - from Alzheimer’s medications. By Dan Hurley
from - Neurology Now September/October 2006
www.neurologynow.com/pt/re/neuronow/pdfhandler.01222928-200602050-00016.pdf;jsessionid=HtNQHJvhpgDwQgJjS8GqkxD3JtFMZnfBfv1vpC2yqBzpZRz12zBn!-1947435345!181195628!8091!-1
Namenda fact sheet
www.alz.org/documents/national/FSmemantine.pdf
----------------------------------------------------------------------------.
- Dosage and administration
All these meds, have side Gastro intestinal side effects (nausea and diarrhea) that are minimized if given at a low dose. After the body acclimates to the med, the dose is increased until the target dose is reached.
Aricept -
Initial dose 5mg, once per day.
Target dose after 4-6 weeks, 10mg. once per day.
Exelon -
Initial dose 1.5mg. twice per day.
Every two weeks increase dose by 1.5 mg. ( step 2 = 3mg. twice per day -- Step 3 = 4.5mg twice per day.)
Target dose = 6mg., twice per day.
(there is now a time release, once per day tablet) Also available as a skin patch.
Razadyne -
Initial Dose 4mg, twice per day.
After 4 weeks, 8mg twice per day.
Target dose - after another 4 weeks (if tolerated) 12mg, twice per day.
Aricept note - Evening dose can cause nightmares.
Aricept can cause nausea. This is especially an issue with aricept because it is given in a once a day dose. As a result, the original approval trials were conducted with the once a day dose given in the evening. It was felt that the nausea would then be better tolerated when the person was sleeping after taking the med. The official recommendation about taking the med in the evening is based on the method used when conducting these trials. However, it was discovered that the aricept can contribute to vivid and disturbing dreams. For this reason, most dementia doctors recommend taking Aricept in the morning.
-----------------------------------------------------/
Combination treatment - Aricept and Namenda in Moderate and late stage.
Question - The pharmacist questioned LO taking both Aricept and Namenda. He is afraid the insurance company will not pay for two memory meds. I thought they complimented each other.
Answer - You are correct, Namenda seems to work better when taken along with aricept. You need to make sure that the pharmacist knows what he is talking about. They are both memory meds, but work differently. A corollary is heart meds. Many people take 3 or 4 different heart meds to keep their condition under control.
www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htmAlzheimer's Disease Medications Fact Sheet - National Institute of Aging
Namenda® is believed to work by regulating glutamate, another important brain chemical that, when produced in excessive amounts, may lead to brain cell death. Because NMDA antagonists work very differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.
--------------------.
From rxlist.com (information similar to Physicians Desk Reference drug guide.)
Study #2 of the Namenda approval trial was conducted with people on aricept, and showed improvement
In a study of 24 weeks duration, 404 patients with moderate to severe probable Alzheimers disease (diagnosed by NINCDS-ADRDA criteria, with Mini-Mental State Examination scores =5 and =14) who had been treated with donepezil for at least 6 months and who had been on a stable dose of donepezil for the last 3 months were randomized to Namenda or placebo while still receiving donepezil. For patients randomized to Namenda, treatment was initiated at 5 mg once daily and increased weekly by 5 mg/day in divided doses to a dose of 20 mg/day (10 mg twice a day).
Namenda/donepezil treatment was statistically significantly superior to placebo/donepezil.
----------------
Namenda.com
The results of a clinical trial published in the Journal of the American Medical Association showed Alzheimer's patients taking Namenda in combination with Aricept® (donepezil) experienced a slower rate of decline in thinking, function and behavior compared to those taking Aricept alone. 1 ( Tariot PN et al. JAMA. 2004 )
The study found that combination therapy with Namenda+Aricept may:
• Improve and maintain thinking
• Help maintain the ability to perform activities of daily living such as grooming, finding belongings and conversing
• Significantly improve behavior
• Delay the onset of negative behavioral symptoms such as agitation, aggression and irritability in asymptomatic people
By treating the symptoms of Alzheimer's disease, Namenda, in combination with Aricept, may do more to treat the symptoms of the disease and allow people with Alzheimer's to recognize and interact with family and friends longer and may help make life more manageable for everyone involved.
---------------------------------------------------------------------.
- Should Aricept be stopped in late stage
FG asks, “ Does aricept really help in late stage Alzheimers. Should we stop Aricept if it is only delaying the inevitable?” (paraphrased)
Stopping Aricept This is a difficult question that does not have a simple answer.
First, to understand the answer you have to know about the unique properties of this med:
- Aricept (also Exelon and Razadyne) does not affect or slow the underlying Alzheimers disease process. What it does do, is preserve and enhance function of the damaged nerve cells in the brain.
- Aricept strengthens the transmission of nerve impulses in the thinking part of the brain and also helps reduce problems of psychosis.
- Because the primary benefit of Aricept is to preserve function, deterioration will still occur, but the person will still function at a higher level than if they were not on the aricept.
- Because the decline still occurs, it is difficult for the caregiver to determine if it is “helping” because they do not know what the person would be like without the Aricept.
- Aricept seems to Protect the weak function of the cells. People who have been removed from Aricept and lost function, do not return to previous level of function if the Aricept is not started soon enough. Somewhere around 4 days to a week is the time frame where Aricept must be restarted to regain lost function. (Namenda does not seem to have this ratchet effect.)
- If a person is off Aricept for more than 4 days, they will need to have the titration period to get back to full strength (to get used to the med and avoid GI disturbance).
- Aricept is still therapeutic at half strength.
At one time, it was felt that aricept only helped for a certain period of time, but Aricept has published studies that show benefit for up to five years. The FDA has now approved aricept for late stage dementia. And Namenda (approved for moderate to late stage Alzheimers) seems to work better when used with Aricept in combination therapy. FDA approval trials for Namenda were conducted that way.
There are two answers often given to the question of when to stop Aricept.
When the person no longer has a quality of life or experiences any pleasure in their life. (I am sure there is a better way to express this)
The other - when there is little mental function to preserve. The theory is that went the damage is so great, and nerves are not functioning well, and there is nothing left to preserve. How do you know when this is?
Another time to reassess is when the person is having problems swallowing pills. The Exelon patch should be a big help at this stage.
Caregivers have stopped Aricept and shortly afterward, their LO lost the ability to walk.
Depending on where the person is in the disease, stopping the aricept might mean the person can no longer feed themselves.
In very late stage, one caregiver on this list stopped Aricept and shortly afterward, their LO lost the ability to swallow. I don’t think they realized the connection, so they never felt remorse about their decision. (Even if they had anticipated this outcome, I do not second guess the highly personal ethical decisions that families must make.)
Doing a search on the web for “stopping aricept” and “when to stop aricept” I found several articles that mentioned that a dramatic loss of function could result when stopping aricept in late stage.
I am a big fan of Dementia practitioner Geri Hall, and she is the only one who has offered a common sense procedure for determining if the Aricept can be stopped. “I decrease my patients' dose to half strength for a week or two. If the family doesn't note a deterioration after halving the drug for two weeks, we stop the drug. If we notice a deterioration at any time we go back to the previous dose.”
This procedure is very similar to the trial reduction that Nursing homes do periodically with antipsychotics. Note that because aricept must be returned to previous dose immediately if decline is seen, everyone must be very vigilant during the reduction. Since your LO is in a nursing home, the doctor must be accessible and willing give the order to change the med level back immediately if warranted. This is not something that can wait until the patient sees the doctor the next time.
- Basic Aricept information
- What is the difference between Aricept and Exelon
- Dosage and administration
- Combination treatment - Aricept and Namenda in Moderate to late stage.
- Should Aricept be stopped in late stage
----------------------------------------
- Basic Aricept information
The following is from the Mayo Clinic regarding medications for A.D. (Originally posted by pepprockk):
Although researchers are developing therapies designed to stop or possibly prevent the progression of Alzheimer's disease, no such therapy is available yet. Instead, current treatments focus on stabilizing the symptoms, improving well-being and easing caregiver burden.
One such treatment option is a class of drugs called cholinesterase (ko-lin-ES-tur-ays) inhibitors, which help improve cognitive function — memory, language, critical thinking, reading and writing. Ronald Petersen, M.D., a neurologist at Mayo Clinic, Rochester, Minn., says that although these drugs are useful, people should be cautious with their expectations. "Cholinesterase inhibitors are not cures," says Dr. Petersen, "but they can provide symptomatic help for some patients, which can improve their quality of life."
How they work
Many areas of the brain deteriorate as Alzheimer's disease progresses. As brain cells die, connections between the cells are destroyed, and symptoms — such as memory loss, confusion, and problems with thinking and reasoning — increase.
Cholinesterase inhibitors stabilize these symptoms by preventing the breakdown of acetylcholine, a chemical that carries impulses between brain cells. These impulses are important for attention, learning and memory. By preventing the breakdown of this chemical, these drugs help maintain the communication pathways between cells.
As the disease progresses and more cells die, however, the brain produces less acetylcholine. Therefore, these medications are most beneficial in the early to middle stages of the disease — generally 3 to 6 years after diagnosis — when levels of acetylcholine are still relatively high.
Several choices available
All cholinesterase inhibitors slow cognitive decline by preventing the breakdown of acetylcholine. But slight differences exist in how the drugs are prepared or how often they're taken.
The Food and Drug Administration (FDA) has approved the following drugs for the treatment of Alzheimer's:
• Donepezil (Aricept). The most commonly prescribed cholinesterase inhibitor is donepezil, which the FDA approved in 1996. In clinical trials, people with Alzheimer's who took donepezil did better on memory and reasoning assessments than did those who were given an inactive substance (placebo). Taken once a day, donepezil is available in tablet form and has a maximum daily dosage of 10 milligrams (mg).
• Galantamine (Reminyl). Galantamine — approved by the FDA in 2001 — is the newest cholinesterase inhibitor on the market. It improves memory and thinking skills for those with Alzheimer's and may reduce behavioral symptoms such as anxiety or aggression. During clinical trials, people usually experienced only mild side effects. Taken twice a day, galantamine is available in tablet form and has a maximum daily dosage of 24 mg.
• Rivastigmine (Exelon). Taken orally twice a day, rivastigmine was approved by the FDA in 2000. Higher doses of rivastigmine may be more effective than lower doses, but may also cause more gastrointestinal problems such as nausea or vomiting. Maximum daily dosage of rivastigmine, which comes in capsule or liquid form, is 12 mg.
Tacrine (Cognex) is another drug that's available. Taken four times a day, tacrine has been on the market since 1993. However, doctors rarely prescribe this drug because of serious side effects, including possible liver damage.
Side effects
In general, these medications cause only mild side effects. Gastrointestinal problems — such as nausea, vomiting or diarrhea — are the most common complaints. Other side effects may include:
• Stomach pain
• Loss of appetite
• Weight loss
• Muscle weakness
Cholinesterase inhibitors can also increase a person's risk of stomach ulcers. Use caution when combining these drugs with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen. When used in combination, the chances of developing stomach ulcers increases even more.
To minimize discomfort, your doctor may prescribe a low dose of the drug and increase it gradually over a period of several weeks. Taking medication with food may also help limit side effects.
What to expect
These drugs don't cure Alzheimer's, but they may slow the progression of the disease. Any beneficial effects — such as improved memory or thinking ability — are usually modest and temporary. And according to the Alzheimer's Association, about half of those who take cholinesterase inhibitors experience no improvement at all in their symptoms.
Furthermore, once the disease advances beyond the moderate stage, these drugs appear to be ineffective and cognitive decline resumes. Possible long-term effects of these medications aren't known, but studies are under way to observe them.
Modest but invaluable
Though modest, improvements in thinking and memory may be seen as invaluable because they can delay the need for caregiver assistance. For example, the medications may extend the period of time in which your loved one is able to bathe or groom without assistance. And they may also delay the need for nursing home care.
These drugs can address other behaviors as well. "Cholinesterase inhibitors may help with noncognitive behaviors such as depression and apathy," says Dr. Petersen. "And some individuals become more energized and interactive on these medications." Others may find these therapies useful in easing challenging behaviors such as aggression or anxiety.
----------------------------------------------------------------------------.
- What is the difference between Aricept and Exelon
Barbara asks, “what is the difference between Aricept and Exelon.
-----------
Exelon and Aricept (and Razadyne) are very similar meds and do exactly the same thing.
Aricept always had an advantage because it could be taken once a day, while exelon had to be taken twice a day. But exelon is now available in an extended release version, so it can be taken once a day also. In general, timed release formulations tend to be better because the levels in the blood are more steady and so there are fewer problems.
Generally, these drugs do exactly the same thing, but there are some differences, so that occasionally, one individual will do poorly on one and do well on another. But overall, and across a large number of patients, One is no better than the other. Or at least that is what the technical VP of the alzheimers association said in one presentation.
----------------
Additional information:
------
Alzheimer's Disease Medications Fact Sheet
www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm
Information Aricept, Exelon and Reminyl
www.alz.org/documents/national/FS_cholinesteraseinhibtors.pdf
www.alz.org/national/documents/topicsheet_treatments.pdf
Article = Dementia Drugs Demystified:
What to expect - and not expect - from Alzheimer’s medications. By Dan Hurley
from - Neurology Now September/October 2006
www.neurologynow.com/pt/re/neuronow/pdfhandler.01222928-200602050-00016.pdf;jsessionid=HtNQHJvhpgDwQgJjS8GqkxD3JtFMZnfBfv1vpC2yqBzpZRz12zBn!-1947435345!181195628!8091!-1
Namenda fact sheet
www.alz.org/documents/national/FSmemantine.pdf
----------------------------------------------------------------------------.
- Dosage and administration
All these meds, have side Gastro intestinal side effects (nausea and diarrhea) that are minimized if given at a low dose. After the body acclimates to the med, the dose is increased until the target dose is reached.
Aricept -
Initial dose 5mg, once per day.
Target dose after 4-6 weeks, 10mg. once per day.
Exelon -
Initial dose 1.5mg. twice per day.
Every two weeks increase dose by 1.5 mg. ( step 2 = 3mg. twice per day -- Step 3 = 4.5mg twice per day.)
Target dose = 6mg., twice per day.
(there is now a time release, once per day tablet) Also available as a skin patch.
Razadyne -
Initial Dose 4mg, twice per day.
After 4 weeks, 8mg twice per day.
Target dose - after another 4 weeks (if tolerated) 12mg, twice per day.
Aricept note - Evening dose can cause nightmares.
Aricept can cause nausea. This is especially an issue with aricept because it is given in a once a day dose. As a result, the original approval trials were conducted with the once a day dose given in the evening. It was felt that the nausea would then be better tolerated when the person was sleeping after taking the med. The official recommendation about taking the med in the evening is based on the method used when conducting these trials. However, it was discovered that the aricept can contribute to vivid and disturbing dreams. For this reason, most dementia doctors recommend taking Aricept in the morning.
-----------------------------------------------------/
Combination treatment - Aricept and Namenda in Moderate and late stage.
Question - The pharmacist questioned LO taking both Aricept and Namenda. He is afraid the insurance company will not pay for two memory meds. I thought they complimented each other.
Answer - You are correct, Namenda seems to work better when taken along with aricept. You need to make sure that the pharmacist knows what he is talking about. They are both memory meds, but work differently. A corollary is heart meds. Many people take 3 or 4 different heart meds to keep their condition under control.
www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htmAlzheimer's Disease Medications Fact Sheet - National Institute of Aging
Namenda® is believed to work by regulating glutamate, another important brain chemical that, when produced in excessive amounts, may lead to brain cell death. Because NMDA antagonists work very differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.
--------------------.
From rxlist.com (information similar to Physicians Desk Reference drug guide.)
Study #2 of the Namenda approval trial was conducted with people on aricept, and showed improvement
In a study of 24 weeks duration, 404 patients with moderate to severe probable Alzheimers disease (diagnosed by NINCDS-ADRDA criteria, with Mini-Mental State Examination scores =5 and =14) who had been treated with donepezil for at least 6 months and who had been on a stable dose of donepezil for the last 3 months were randomized to Namenda or placebo while still receiving donepezil. For patients randomized to Namenda, treatment was initiated at 5 mg once daily and increased weekly by 5 mg/day in divided doses to a dose of 20 mg/day (10 mg twice a day).
Namenda/donepezil treatment was statistically significantly superior to placebo/donepezil.
----------------
Namenda.com
The results of a clinical trial published in the Journal of the American Medical Association showed Alzheimer's patients taking Namenda in combination with Aricept® (donepezil) experienced a slower rate of decline in thinking, function and behavior compared to those taking Aricept alone. 1 ( Tariot PN et al. JAMA. 2004 )
The study found that combination therapy with Namenda+Aricept may:
• Improve and maintain thinking
• Help maintain the ability to perform activities of daily living such as grooming, finding belongings and conversing
• Significantly improve behavior
• Delay the onset of negative behavioral symptoms such as agitation, aggression and irritability in asymptomatic people
By treating the symptoms of Alzheimer's disease, Namenda, in combination with Aricept, may do more to treat the symptoms of the disease and allow people with Alzheimer's to recognize and interact with family and friends longer and may help make life more manageable for everyone involved.
---------------------------------------------------------------------.
- Should Aricept be stopped in late stage
FG asks, “ Does aricept really help in late stage Alzheimers. Should we stop Aricept if it is only delaying the inevitable?” (paraphrased)
Stopping Aricept This is a difficult question that does not have a simple answer.
First, to understand the answer you have to know about the unique properties of this med:
- Aricept (also Exelon and Razadyne) does not affect or slow the underlying Alzheimers disease process. What it does do, is preserve and enhance function of the damaged nerve cells in the brain.
- Aricept strengthens the transmission of nerve impulses in the thinking part of the brain and also helps reduce problems of psychosis.
- Because the primary benefit of Aricept is to preserve function, deterioration will still occur, but the person will still function at a higher level than if they were not on the aricept.
- Because the decline still occurs, it is difficult for the caregiver to determine if it is “helping” because they do not know what the person would be like without the Aricept.
- Aricept seems to Protect the weak function of the cells. People who have been removed from Aricept and lost function, do not return to previous level of function if the Aricept is not started soon enough. Somewhere around 4 days to a week is the time frame where Aricept must be restarted to regain lost function. (Namenda does not seem to have this ratchet effect.)
- If a person is off Aricept for more than 4 days, they will need to have the titration period to get back to full strength (to get used to the med and avoid GI disturbance).
- Aricept is still therapeutic at half strength.
At one time, it was felt that aricept only helped for a certain period of time, but Aricept has published studies that show benefit for up to five years. The FDA has now approved aricept for late stage dementia. And Namenda (approved for moderate to late stage Alzheimers) seems to work better when used with Aricept in combination therapy. FDA approval trials for Namenda were conducted that way.
There are two answers often given to the question of when to stop Aricept.
When the person no longer has a quality of life or experiences any pleasure in their life. (I am sure there is a better way to express this)
The other - when there is little mental function to preserve. The theory is that went the damage is so great, and nerves are not functioning well, and there is nothing left to preserve. How do you know when this is?
Another time to reassess is when the person is having problems swallowing pills. The Exelon patch should be a big help at this stage.
Caregivers have stopped Aricept and shortly afterward, their LO lost the ability to walk.
Depending on where the person is in the disease, stopping the aricept might mean the person can no longer feed themselves.
In very late stage, one caregiver on this list stopped Aricept and shortly afterward, their LO lost the ability to swallow. I don’t think they realized the connection, so they never felt remorse about their decision. (Even if they had anticipated this outcome, I do not second guess the highly personal ethical decisions that families must make.)
Doing a search on the web for “stopping aricept” and “when to stop aricept” I found several articles that mentioned that a dramatic loss of function could result when stopping aricept in late stage.
I am a big fan of Dementia practitioner Geri Hall, and she is the only one who has offered a common sense procedure for determining if the Aricept can be stopped. “I decrease my patients' dose to half strength for a week or two. If the family doesn't note a deterioration after halving the drug for two weeks, we stop the drug. If we notice a deterioration at any time we go back to the previous dose.”
This procedure is very similar to the trial reduction that Nursing homes do periodically with antipsychotics. Note that because aricept must be returned to previous dose immediately if decline is seen, everyone must be very vigilant during the reduction. Since your LO is in a nursing home, the doctor must be accessible and willing give the order to change the med level back immediately if warranted. This is not something that can wait until the patient sees the doctor the next time.
