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Discontinuation of donepezil for the treatment of Alzheimer's disease in geriatric practice

Published online by Cambridge University Press:  01 August 2008

Hiroyuki Umegaki ,
Akio Itoh ,
Yusuke Suzuki  and
Toshitaka Nabeshima
Hiroyuki Umegaki*
Affiliation:
Department of Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
Akio Itoh
Affiliation:
Department of Hospital Pharmacy, Nagoya University Graduate School of Medicine, Aichi, Japan
Yusuke Suzuki
Affiliation:
Department of Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
Toshitaka Nabeshima
Affiliation:
Department of Chemical Pharmacology, Meijo University Graduate School of Pharmaceutical Sciences, Aichi, Japan
*
Correspondence should be addressed to: Hiroyuki Umegaki, Department of Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan. Phone: +81 52 744 2365; Fax: +81 52 744 2371. Email: umegaki@med.nagoya-u.ac.jp.
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Abstract

Background: Maintaining continuous pharmacological treatment of patients with dementia is often difficult. In the current study we surveyed the discontinuation of donepezil, a cholinesterase inhibitor, for the treatment of Alzheimer's disease in a Japanese geriatric outpatient clinic in a university hospital.

Methods: Using a retrospective chart review from 1 July 2003 to 30 June 2005, prescriptions of donepezil and the reasons for discontinuing the prescription in a university hospital were determined. The severity of dementia was evaluated by the clinical dementia rating (CDR).

Results: Out of 264 patients, 140 (53.1%) discontinued taking donepezil during the two-year observation period. The mean age of the continued group and the discontinued group did not differ significantly (79.5 ± 6.7, 79.8 ± 6.4, respectively). Kaplan-Meier analysis showed that the patients with more severe cognitive impairment (CDR score = 3) discontinued donepezil earlier and more frequently. The reasons for discontinuation were a change in the doctors treating the patients (n = 71), ineffectiveness (n = 16), gastrointestinal side-effects (n = 11), and others (n = 41). In patients with CDR = 1 or 2, changes of doctors were the most frequent reason for discontinuation. However, in patients with CDR = 3, ineffectiveness of the medication was the major reason for discontinuation.

Conclusion: Donepezil was frequently discontinued, and the rate of discontinuation was higher in patients with advanced dementia.

Keywords

Alzheimer's diseasedonepezilcholinesterase inhibitorclinical dementia rating
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 4 , August 2008 , pp. 800 - 806
Copyright
© International Psychogeriatric Association 2008

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