Impact of nighttime donepezil administration on sleep in the older adult population: A retrospective study

Abstract

Introduction . Although not definite, studies are finding Alzheimer's disease may be related to loss of cholinergic innervation. In order to impact this loss of function, therapeutic agents have been developed to reduce the breakdown of acetylcholine, a neurotransmitter vital in cognitive processes. Donepezil has been used in Alzheimer's disease for improving cognition. Although the package insert suggests nighttime administration to reduce the instance of daytime side effects, some patients report sleep disturbances. Methods . Patient charts at the Tallahassee Memorial Healthcare Neuroscience Center (TMH-NSC) were reviewed. Charts of those patients who met the inclusion criteria were used to determine the correlation between night time administration of donepezil and sleep disturbances. Results . A total of 186 patient charts were analyzed. Of those 186, 103 of the patients were taking donepezil as directed in the package labeling, at night time. Nearly half (47.6%) of the patients taking donepezil at night reported night time disturbances (NTD) and only 21 of the 83 patients taking donepezil in the morning reported NTD. Conclusion . This retrospective study showed that taking donepezil at night may be associated with sleep disturbances. Although labeling suggests administration in the evening, should NTDs occur, changing the medication administration to the morning should be explored before switching therapeutic agents.

Evaluation of the Adverse Effects of Chronic Exposure to Donepezil (An Acetylcholinesterase Inhibitor) in Adult Zebrafish by Behavioral and Biochemical Assessments

“…This result indicated that there was a possibility of DPZ having an effect in sleep disturbance, even in the absence of melatonin alteration. In a prior study, the potential effect of DPZ after its administration was discovered, as sleep efficiency was increased with shortened sleep latency in patients with Alzheimer's Type Dementia (ATD) [54], having an adverse effect in a patient with night-time disturbance (NTD); thus, more research about the time of administration of DPZ is necessary [98]. However, one has to keep in mind that, even though the daily rhythms of locomotor activity in adults and larvae zebrafish can be attributed to the circadian system, there are other ways to evaluate circadian rhythms in zebrafish besides locomotor activity, namely, hormone levels and sleep behaviors, such as sleep latency or sleep bouts/efficiency.…”

Evaluation of the Adverse Effects of Chronic Exposure of Donepezil (An Acetylcholinesterase Inhibitor) in Adult Zebrafish by Behavioral and Biochemical Assessments

“…This result indicated that there was a possibility of DPZ having an effect in sleep disturbance, even in the absence of melatonin alteration. In a prior study, the potential effect of DPZ after its administration was discovered, as the sleep efficiency was increased with shortened sleep latency in patients of Alzheimer's Type Dementia (ATD) [32], having an adverse effect in a patient with night-time disturbance (NTD); thus, more research about the time of administration of DPZ is necessary [77]. However, one has to keep in mind that, even though the daily rhythms of locomotor activity in adults and larvae zebrafish can be attributed to the circadian system, there are other ways to evaluate circadian rhythms in zebrafish besides locomotor activity; namely, hormone levels and sleep behaviors, such as sleep latency or sleep bouts/efficiency.…”

GABA-enriched fermented Laminaria japonica improves cognitive impairment and neuroplasticity in scopolamine- and ethanol-induced dementia model mice

“…This would suggest a similar mechanism to that of current primary treatments for AD patients, including donepezil, tacrine, rivastigmine and galantamine - nonselective AChE inhibitors. These drugs have been tested and show efficacy in treating AD-related cognitive symptoms, however not without the side effects including, night time disturbances [ 7 ], gastrointestinal [ 6 ] and cardiovascular complications [ 8 ].…”

“…These muscarinic agonist drugs act through the inhibition of acetylcholinesterase (AChE), responsible for breaking down acetylcholine (ACh) in the neural synapse. However, the effectiveness of these drugs differs from patient to patient, and adverse effects have been reported including, gastrointestinal symptoms [ 6 ], night time disturbances [ 7 ] and cardiovascular complications [ 8 ]. Thus, the administration of a naturally occurring substance, which potentially has the same alleviative potency as a synthetic psychotropic drug, would be of great interest to the medical field.…”