The active ingredient is donepezil. Available in dosages of 5 and 10 mg. Donepezil is a white round tablet. Aricept blocks the enzyme acetylcholinesterase and thereby slows down the breakdown of the mediator - acetylcholine, which is involved in the transmission of nerve impulses in the central nervous system. It inhibits the development and progression of Alzheimer's disease, reduces the development and severity of cognitive impairments, as well as apathy, hallucinations, and repetitive movements.
Taken orally. Absorption occurs in the digestive tract. Food intake does not affect the absorption time. The maximum concentration is reached in plasma after 4 hours. Half-life 70 hours. It is metabolized in the liver, binds to proteins by 95%. It is excreted by the kidneys up to 79%, the rest through feces. It remains in the body for up to 10 days after stopping the intake. With a constant intake once a day, a constant average concentration is established after 3 weeks.
Aricept is used in the symptomatic treatment of cognitive impairment in mild to moderate Alzheimer's disease.
Aricept is used only as directed by the doctor and doctor’s control. Adequate patient care is essential for effective therapy. The drug should be used only once a day before bedtime. Take no longer than 6 weeks. If the treatment stops working, the medication should be discontinued.
Take 1 tablet at bedtime. The initial dosage is 5 mg once a day, after a month, an increase to 10 mg per day is permissible. Drink with water. The course is 6 weeks. Continue taking if the therapeutic effect is noticed
When using a dosage higher than 10 mg with a single dose or increasing the frequency of administration and the daily dose, a cholinergic crisis can play.
Hodinergic crisis is a complex of symptoms arising under the action of an excess of acetylcholine on muscarinic and nicotinic receptors, stimulation of the neuromuscular synapse increases, resulting in flaccid paralysis.
Symptoms: increased sweating, drooling, lacrimation, nausea, vomiting, pupillary constriction, urination, defecation, muscle spasm, decreased heart rate, lower blood pressure, convulsions, development of collapse, respiratory failure.
Treatment: symptomatic. Atropine in a dosage of 1-2 mg IV serves as an antidote when it affects muscarinic receptors. At the same time, the effect on nicotinic receptors remains unchanged. It is possible IVL with the development of respiratory failure before the cessation of the drug. Peritoneal dialysis, hemodialysis, hemofiltration has not been studied.
All contraindications can be divided into absolute and relative. Absolute contraindications include individual intolerance to the drug and piperidine.
Relative ones include:
- chronic heart disease, such as rhythm disturbances, - peptic ulcer of the stomach and duodenum, - simultaneous intake of non-steroidal anti-inflammatory drugs, anticholinergic antagonists, cholinesterase inhibitors, - childhood
Aricept is contraindicated for use in pregnant women and women who are breastfeeding.
Side effects that develop frequently: diarrhea, nausea, vomiting, fainting, headache, dizziness, agitation, hallucinations, unreasonable aggression, insomnia, gastrointestinal disorders, urinary incontinence, itching, rash. Rarely, it is possible to develop heart disorders in the form of bradycardia and AV blockade, gastric ulcer, duodenal ulcer, gastrointestinal bleeding, convulsions, increased serum CPK, etc.
Clinical trials conducted with the use of donepezil with other drugs are limited. The cytochrome P450 system, namely CYP3A4 and CYP2D6, is involved in the metabolism of donepezil. It follows that drugs that suppress these isozymes reduce the metabolism of donepezil. CYP3A4 and CYP2D6 inhibitors include ketoconazole, quinidine, erythromycin, itraconazole, fluoxetine. Medicines that induce these enzymes, such as carbamazepine, rifampicin, phenytoin, ethanol, cause a decrease in donepezil.
Before prescribing this treatment, the primary physician should carefully study the patient's history and chronic diseases. Aricept is prescribed with caution and under the supervision of the primary physician for chronic obstructive pulmonary diseases, in particular COPD, bronchial asthma, cardiac arrhythmias, gastric ulcer and duodenal ulcer, as well as concomitant use with nonsteroidal anti-inflammatory drugs (NSAIDs), anticholinergics, cholinesterase inhibitors.
It is not recommended to use in conjunction with anesthesia, since Aricept enhances the relaxation of muscle of the succinylcholine type.
Donepezil has a vagotonic effect on the heart, due to which it causes bradycardia, especially significant in sick sinus syndrome, supraventricular tachycardia, sinoatrial and AV blockades.
There are studies confirming that cholinomimetics can cause seizures of a generalized nature, but in Alzheimer's disease, seizures can occur on their own.
Treatment with the drug is prescribed by a physician experienced in Alzheimer's disease. For maintenance, therapy is used if there is a therapeutic effect of the drug.
No studies have been conducted to date on the treatment of patients with severe Alzheimer's or other types of dementia.
Driving a vehicle. Donepezil causes dizziness, muscle cramps and fatigue, especially at the beginning of treatment. In addition, dementia itself causes impairments to the ability to drive cars and other equipment. The decision about driving is made by the primary physician for each patient individually, considering the course of the disease and the body's response to treatment.
First of all, dementia and Alzheimer's are not the same thing. Dementia is not always Alzheimer's, but any Alzheimer's is accompanied by dementia.
Dementia is a deterioration in memory that grows over time, a person's mental abilities and his ability to cope with everyday activities decrease. Over time, a moment comes when a person cannot even cope with caring for himself without assistance. There are many causes of dementia. Vascular dementia as a result of recurrent cerebrovascular disorders, frontotemporal dementia as a result of degeneration of the temporal and frontal lobes, Parkinson's disease and the most common Alzheimer's disease are distinguished.
Alzheimer's disease is a chronic disease of the nervous system, described by the scientist Alzheimer in 1906, after whom it was named. The disease proceeds with slow damage to neurons - brain cells and, as a result, the death of brain tissue. Cell death leads to impaired memory, decreased mental abilities.
Alzheimer's disease can be early-onset and late-onset. An early onset is considered a disease that begins before the age of 65. The mechanisms of occurrence are still not known. Scientists give a vase role to heredity, human lifestyle and the environment. The main risk factor is age, minor ones: smoking, depression. Alzheimer's disease is more common with late onset.
Organic manifestations of the disease in the tissues of the brain appear much earlier than the symptoms of the disease itself. In brain cells - neurons, amyloid protein and tau protein, which are pathological, begin to be deposited. These proteins lead in the future to the death of cells and tissues in general - atrophy.
The very first and most common symptom is memory impairment. At first, this symptom is difficult to distinguish from the normal, natural loss of memory in the elderly. The main feature of memory loss at the onset of the disease is that patients forget details: close the door before leaving, lose keys, leave the stove on and/or a pan on it when cooking, some recipes replace others, cleaning the house becomes chaotic. For people, whose professions are related to science, education later develop all other symptoms. Their brains can take a long time to cope with changes. The disease in all people occurs individually. For some, the memory sphere suffers later, and the first symptoms may be difficulty in finding words, recognizing faces and finding the way home.
In the course of the disease, it is divided into mild dementia and severe dementia. At the beginning, with mild dementia, the patient himself notices his problems, tries to cope with them, seeks help. The best time to diagnose a disease.
Further, the disease worsens and progresses. A person's interests are lost, he cannot learn something new, for example, the operation of a new phone, asks the same questions, tells the same stories, self-care worsens - clothes become sloppy, hair dirty.
Criticism disappears, attention decreases, people do not remember the date, what season, their address, time of year and where they are now. Patients do not notice changes around them, but periods of clarity do occur. They are usually very short-lived. Mental disorders appear, anxiety, suspicion and even aggression. Patients begin to forget their relatives and friends; sleep and circadian rhythm are disturbed. A person is more active at night than during the day. In the later stages, a person simply loses the ability to serve himself, ceases to understand speech and speak, cannot get out of bed, dress, eat, or go to the toilet.
Therefore, such patients are assigned a guardian. A trustee is a person who represents the personal, property rights of a sick person. Appointed by the court.
The main prevention of the disease is learning new material, teaching new skills and abilities.
Learning foreign languages. Daily language classes for up to 30 minutes a day strengthen the connection between neurons and improve a person's memory. Polyglots suffer from Alzheimer's much less often than people who know only one language.
Control and avoidance of stressful situations. Cognitive impairment has been shown to develop as a result of stress. Elderly people often experience depression and anxiety. This is influenced by many factors, including: retirement, loss of status, health status, inability to do what you love, etc.
Meditation is one of the modern and successful techniques that help to distract from stress. In 2013, a study was conducted, and it was found that the elderly who practice yoga are much less likely to have cerebral cortex atrophy.
Healthy sleep. A normal 7–8-hour sleep is a guarantee of health and one of the measures to prevent the disease. Without sleep, a person has an increased production of the hormone cortisol, which is a "stress hormone" and increases the likelihood of developing Alzheimer's.
Rejection of bad habits. Scientists have found that dementia develops more often in smokers by 45%.
Exercise. Sports activities help to preserve the volume of the hippocampal tissue for a long time - an area that is one of the first to be affected in Alzheimer's.
Proper nutrition. Elimination of sugar from the diet. Reveals a direct link between Alzheimer's and diabetes mellitus. There is evidence that type 3 diabetes is Alzheimer's disease, the result of insulin resistance in brain cells. Eating a lot of vegetables, fruits, herbs. In addition to fiber, these foods are high in flavonoid, which has anti-inflammatory properties and prevents aging of human cells. Eating sea fish, which contains Polyunsaturated Fatty Acid (PUFA) and a protein that helps cells regenerate, protects neurons and prevents blood clots. Taking vitamin complexes based on vitamins B, A, E, K and PP.
The disease itself causes a complete loss of cognitive functions, which makes the patient incapacitated. The patient cannot report the pain, what bothers him, is not able to take medications on his own and speak if there are side effects. Patients often hospitalized with aspiration, pneumonia, fractures, bedsores, malnutrition, and dehydration. It is precisely, that patients cannot report early symptoms and consequently leads to serious illnesses, leading to death.
Dementia has been around for hundreds of years. And since that time, people have tried to treat it on their own. In traditional medicine, there are several plants that have a beneficial effect on the course of the disease.
Chinese club moss is a widely used herb in China. The main active ingredient in it is huperzine. It improves perception and has a beneficial effect on a person's memory. According to a study, 200 mcg per day of huperzine for 3 months significantly increases cognitive function in 50% of cases.
Coconut oil is rich in ketones, foods that improve the functioning of nerve cells.
Ginseng. In a study that lasted 10 years among 40 patients, 25 patients noted an improvement in memory after 12 weeks of admission.
Sage improves blood flow, vascular function, reducing blood clots.
Maintaining normal vitamin D levels increases the efficiency of glial cells, which restore neuronal function. Vitamin D is an immunomodulator and has anti-inflammatory properties, which also has a beneficial effect on the course of the disease.
Ginkgo - contains many antioxidants and substances that improve blood rheology.
Alpha lipoic acid improves brain function and may slow the progression of disease.
You can find data that Alzheimer's disease is spreading every year, some scientists even call it an epidemic. If you look up the statistics of this disease around the world, you can find that in 2014 the number of patients was no more than 36 million people, by 2018 Dick's figure is already above 50 million people. The disease has a serious effect on human brain activity and affects particularly important areas: memory deteriorates, intelligence decreases, and as a result, a person's personality deforms. Symptoms progress from year to year, most patients do not understand and simply are not able to realize their condition. Alzheimer's disease is still incurable, but early diagnosis is important to slow the development of the late progression of the disease.