New Acetylcholinesterase Inhibitor (Donepezil) Treatment for Alzheimer’s Disease in a Chronic Dialysis Patient

Suwata, Junji; Kamata, Kohzoh; Nishijima, Tatsushige; Yoshikawa, Toru; Sano, Masaaki

doi:10.1159/000058413

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…It is known that donepezil is well absorbed, reaching peak plasma concentrations within 4 h [6]. A 5-h interval following donepezil administration might be beneficial to dialysis patients [7]. The results of 5 mg single-dose trials in patients with impaired renal function compared with patients from a healthy control group indicated no difference in pharmacokinetics of donepezil [32].…”

Section: Discussionmentioning

confidence: 99%

“…We began donepezil administration with the lower dose of 2.5 mg/day orally and enhanced the dose to 5 mg/day 1 month later. Suwata et al [7] reported that whenever dialysis was starting 1 h after the administration of donepezil, an extraordinary elevation appeared in the plasma concentration time curve of donepezil, a fact that was not observed if donepezil was administered at least 5 h before the dialysis session. Taking into consideration these findings, we followed the same technique keeping, a 5-h interval between donepezil administration and dialysis session.…”

Section: Case Seriesmentioning

confidence: 99%

“…Unfortunately, in our hospital where the study patients were followed and hemodialyzed, any method of monitoring plasma levels of donepezil or its three metabolites [7] was unavailable. We were reluctant to ask our physically and economically fragile patients for a repetitional measurement in a private laboratory, especially since we noted no clinical sign of elevated levels of the drug, such as bradycardia, diarrhea, or confusion.…”

Section: Case Seriesmentioning

confidence: 99%

“…Their findings suggest that the pharmacokinetics of donepezil does not change in patients with moderately to severely impaired renal function. There is also only one case report with successful donepezil treatment in a chronic dialysis patient [7].…”

Section: Introductionmentioning

confidence: 99%

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Donepezil Treatment for Alzheimer’s Disease in Chronic Dialysis Patients

Yiannopoulou

Anastasiou

Kyrozis

et al. 2019

Case Rep Nephrol Dial

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Donepezil is one of the cholinesterase inhibitors that are indicated for the treatment of mild to moderate Alzheimer’s disease (AD). Pharmacokinetic analysis has shown that donepezil is primarily eliminated by renal excretion rather than biliary excretion in humans. Therefore, patients with impaired renal function are at high risk of toxicity caused by accumulation of this drug. It is also well known that dialysis patients have very often cholinergic disorders. On the other hand, with the increasing number of long-term chronic dialysis patients, the prevalence of cognitive disorders is increasing in elderly dialysis patients. Because of the above-mentioned special risks of these patients, acetylcholinesterase inhibitors, such as donepezil, are avoided to be prescribed for them. We studied 5 cases of chronic hemodialysis outpatients (3 men [70, 72, and 86 years old] and 2 women [65 and 71 years old]) who were diagnosed as having moderate AD. We administered donepezil at 2.5 mg/day orally to the patients. After 1 month’s treatment, their behavioral symptoms were improved, without them having any adverse events. We enhanced the dose to 5 mg/day without the patients experiencing any episodes of drug toxicity. After 3 months of treatment with the higher dose, their cognitive and executive functions were slightly improved and their behavioral disorders were remarkably milder, without them experiencing any episodes of drug toxicity. The patients’ condition remained stable for 6 months after the initial administration of the drug. All of them were followed for the 10 following years, showing a mild cognitive decline per year for the first 5 years and more severe decline for the remaining years of the follow-up. Our cases indicate that donepezil treatment under prudent use may be well tolerated and have a beneficial impact on chronic hemodialysis patients with AD.

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Section: Discussionmentioning

confidence: 99%

Section: Case Seriesmentioning

confidence: 99%

Section: Case Seriesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Donepezil Treatment for Alzheimer’s Disease in Chronic Dialysis Patients

Yiannopoulou

Anastasiou

Kyrozis

et al. 2019

Case Rep Nephrol Dial

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Pregnancy and Breastfeeding

2021

The Maudsley Prescribing Guidelines in Psychiatry

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Lifestyle factors have an important influence on pregnancy outcome. It is well established that smoking cigarettes, eating a poor diet and drinking alcohol during pregnancy can have adverse consequences for the foetus. The manufacturers of cariprazine have advised against its use in pregnancy because of an increased risk of malformations noted in animal studies. Women who take antidepressants during pregnancy may be at increased risk of developing hypertension, preeclampsia and postpartum haemorrhage. Lithium exposure during pregnancy has been associated with an increased risk of congenital anomalies. Anxiety disorders and insomnia are commonly seen in pregnancy. The long‐term benefits of breastfeeding on child physical health and cognitive development are well known. Discussions about the safety of drugs in breastfeeding should be held as early as possible ideally before conception or early in pregnancy. It is usually advisable to continue the antidepressant prescribed during pregnancy.

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Hepatic and Renal Impairment

2021

The Maudsley Prescribing Guidelines in Psychiatry

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Patients with hepatic impairment may have: reduced capacity to metabolise, reduced ability to synthesise, and reduced hepatic blood flow. Liver function tests (LFTs) are a poor marker of hepatic metabolising capacity, as the hepatic reserve is large. There are few clinical studies relating to the use of psychotropic drugs in people with hepatic disease. The development of metabolic syndrome may be linked to the emergence of non‐alcoholic fatty liver disease later in treatment. Of those treated with antidepressants, 0.5‐3% develop asymptomatic mild elevation of hepatic transaminases. Almost any type of liver damage can occur, ranging from mild transient asymptomatic increases in LFTs to fulminant hepatic failure. Using drugs in patients with renal impairment needs careful consideration. This is partly because some drugs are nephrotoxic but principally because the pharmacokinetics of drugs are altered in renal impairment.

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New Acetylcholinesterase Inhibitor (Donepezil) Treatment for Alzheimer’s Disease in a Chronic Dialysis Patient

Cited by 6 publications

References 8 publications

Donepezil Treatment for Alzheimer’s Disease in Chronic Dialysis Patients

Donepezil Treatment for Alzheimer’s Disease in Chronic Dialysis Patients

Pregnancy and Breastfeeding

Hepatic and Renal Impairment

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