How does it work?

Aricept tablets and Aricept Evess tablets both contain theactive ingredient donepezil hydrochloride, which is a type of medicine calledan acetylcholinesterase inhibitor. It works by slowing the breakdown of acompound in the brain called acetylcholine.

Acetylcholine is a natural compound known as a neurotransmitter.Neurotransmitters are stored in nerve cells in the brain and nervous system,and are involved in transmitting messages between the nerve cells. They arenecessary for the normal functioning of the brain and nervous system.Acetylcholine in the brain is continually being released by nerve cells, andthen broken down by another natural chemical called acetylcholinesterase.

One of the features of Alzheimer's disease appears to be a lowerthan normal level of acetylcholine in the brain. This is due in part todegeneration of brain cells, in particular those that normally releaseacetylcholine.

Donepezil increases the level of acetylcholine in the brain. Itdoes this by preventing the action of acetylcholinesterase, the compound thatnormally breaks it down. This slows the breakdown of acetylcholine that isreleased from remaining undamaged nerve cells in the brain.

The result of this is increased activity of acetylcholine in thebrain. This improves the cognitive processes of thinking, learning and memory,and improves the symptoms of dementia and daily functioning in Alzheimer'sdisease.

Donepezil is used to treat mild to moderately severe dementia inpeople with Alzheimer's disease. However, it only slows the worsening of thedementia, rather than being a cure. As a result, your doctor will want tore-assess the patient after they have been taking the medicine for two to fourmonths at the maintenance dose. If there has been no improvement in theirsymptoms, or they continue to deteriorate, your doctor may decide it is notworth continuing the medicine. For patients who continue treatment, the benefitof the medicine should be reassessed on a regular basis. The medicine should bestopped when it is considered that it is no longer providing a beneficialeffect.

Aricept tablets are standard tablets. Aricept Evess tablets areknown as 'orodispersible tablets'. They are designed to disintegrate on thetongue in the saliva and then be swallowed either with or without a drink, asthe patient prefers. These tablets may be useful for people who don't like totake or can't swallow standard tablets. Both types of tablet should be takenonce a day, in the evening before going to bed.

What is it used for?

• Mild to moderately severe Alzheimer's dementia.

Warning!

• The benefit of this medicine in treating dementia or memory loss that are due to causes other than Alzheimer's disease has not been demonstrated. It should only be used to treat dementia that has been confirmed as Alzheimer's disease by a doctor experienced in treating Alzheimer's.
• A doctor will only prescribe this medicine if the patient has a caregiver available who will regularly make sure that the patient is taking the medicine.
• This medicine may cause fatigue, dizziness and muscle cramps, particularly when starting treatment or increasing the dose. As a result it may reduce the patients ability to perform potentially hazardous tasks safely.

Use with caution in

• Decreased liver function.
• A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome).
• Disturbances of the heart's electrical message pathways (heart conduction defects, eg heart block).
• History of peptic ulcer.
• People taking long-term non-steroidal anti-inflammatory drugs (NSAIDs) eg diclofenac, indometacin.
• History of difficulty passing urine (urinary obstruction).
• Parkinson's disease.
• Epilepsy.
• Asthma.
• Chronic obstructive pulmonary disease (COPD).

Not to be used in

• Children.
• Breastfeeding.
• Aricept standard tablets contain lactose and are not suitable for people with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption.

This medicine should not be used if you are allergic to one orany of its ingredients. Please inform your doctor or pharmacist if you havepreviously experienced such anallergy.If you feel you haveexperienced an allergic reaction, stop using this medicine and inform yourdoctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy orbreastfeeding. However, other medicines may be safely used in pregnancy orbreastfeeding providing the benefits to the mother outweigh the risks to theunborn baby. Always inform your doctor if you are pregnant or planning apregnancy, before using any medicine.

• The safety of this medicine for use during pregnancy has not been established. It should not be used during pregnancy unless considered essential by your doctor. Seek medical advice from your doctor.
• It is not known if this medicine passes into breast milk. It should not be used by women who are breastfeeding. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individualpeople in different ways. The following are some of the side effects that areknown to be associated with this medicine. Because a side effect is statedhere, it does not mean that all people using this medicine will experience thator any side effect.

• Nausea and vomiting.
• Loss of appetite.
• Diarrhoea.
• Fatigue.
• Difficulty in sleeping (insomnia).
• Headache.
• Dizziness.
• Fainting.
• Hallucinations.
• Agitation.
• Aggressive behaviour.
• Muscle cramps.
• Urinary incontinence.
• Rash or itching.
• Ulceration or bleeding in the stomach or intestines.
• Slow heart rate (bradycardia).
• Seizure.
• Liver disorders, eg hepatitis.
• Abnormal movements of the hands, legs, face, neck and tongue, eg tremor, twitching, rigidity (extrapyramidal effects).

The side effects listed above may not include all of the sideeffects reported by the drug'smanufacturer.For moreinformation about any other possible risks associated with this medicine,please read the information provided with the medicine or consult your doctoror pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicinesthe patient is already taking, including those bought without a prescriptionand herbal medicines, before they start treatment with this medicine.Similarly, check with your doctor or pharmacist before any new medicines aretaken with this one, to ensure that thecombination is safe.

This medicine should not be taken with other medicines thatincrease the activity of acetylcholine, as this may increase the risk of sideeffects. These medicines include the following:

• medicines for myaesthenia gravis, eg neostigmine, edrophonium chloride, distigmine bromide, pyridostigmine bromide
• other medicines for Alzheimer's disease, eg galantamine, rivastigmine
• certain medicines for urinary retention, eg bethanechol chloride, distigmine
• pilocarpine.

This medicine has an opposite effect to anticholinergicmedicines, which work by decreasing the activity of acetylcholine. If takentogether, anticholinergic medicines and donepezil could therefore oppose eachother's effects, which could make one or both medicines less effective. As aresult, anticholinergic medicines should be avoided by people taking donepezil.They include the following:

• anticholinergic medicines for Parkinson's disease, eg procyclidine, benzatropine, orphenadrine, trihexyphenidyl
• ipratropium bromide for asthma
• antispasmodics for gut disorders, eg hyoscine, atropine, propantheline
• medicines for urinary incontinence, eg oxybutinin, flavoxate, tolterodine, propiverine, trospium.

The following medicines may possibly increase the amount ofdonepezil in the blood:

• erythromycin
• fluoxetine
• itraconazole
• ketoconzole
• quinidine.

The following medicines may possibly decrease the amount ofdonepezil in the blood:

• carbamazepine
• phenytoin
• rifampicin.

Other medicines containing the same active ingredient

There are currently no other medicines available in the UK thatcontain donepezil as the active ingredient.