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Alzheimer's Disease

Aricept - Could Less Be Better?

04/17/2009

Question:

In January my mother was diagnosed with an untyped form of dementia. The Doctor felt it was not Alzheimer`s based on symptoms but likely related to earlier TIAs mother had. So they started her on Aricept. After 3 weeks she really was doing better, then after 4, they increased the dose from 5mg to 10mg. It seemed to me in that next week she got a bit worse and then leveled off there. Now, 4 months into the treatment she can barely remember names -- names of people, places or things. She can talk to you about anything but can`t bring up those details.

Is it possible that 10mg is `overkill`...is the drug dosed by weight? She`s only 90 pounds (4`8"), how much would be `right` in that case? I trust her doctor but also wonder how much experience anyone has administering this drug to someone who is about the size of a 10-year-old? I mentioned to her doctor in our last visit that I thought she was doing better before the 10mg increase but, the doctor didn`t seem to think we should back down.

I`ve also read that vitamin E along with the Aricept is more beneficial than Aricept alone, has that been proven?

We could be one of the unlucky ones that won`t see the miraculous results that others report with Aricept but if there`s any chance to help my mother, I would like to explore them. I just don`t know how to approach this with the doctor at this point.

Answer:

For most individuals, Aricept 10 mg works a little bit better than 5 mg. However, if it seems that she is possibly having a side effect with the 10 mg, one can always back down to 5 mg and see if it makes a difference in her symptoms. The dose of a medicine may depend on other factors. Aricept is metabolized in the liver. So if her liver is not working well that could cause a possible toxic dose. Other drugs may interfere as well.

Aricept is usually well tolerated. The most common side effects are weight loss, nausea, and diarrhea. We have many 90 pound individuals who have no problem with 10 mg Aricept. However, every individual is different. Vitamin E 200 i.u. daily is very safe and may be helpful in come dementia conditions. This has not been proven. In patients with Alzheimer's disease, Namenda is often used in combination with Aricept to help cognitive impairments. This could be discussed with her doctor as well.

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Response by:

Douglas W Scharre, MD Douglas W Scharre, MD
Clinical Associate Professor of Neurology
Clinical Associate Professor of Psychiatry
College of Medicine
The Ohio State University