Table 4.

APEX recommendations for the use of donepezil 23 mg/day in the treatment of moderate-to-severe AD

Ensure an accurate diagnosis of moderate-to-severe AD – evaluate cognition, function, and behavior.

Assess for contraindications and cautions to donepezil – low body weight ( 55 kg), history of GI bleeding, and atrioventricular block.

Review medical history – manage comorbid conditions, provide education, support, and referrals to support groups or social workers for patient and caregivers.

Nonpharmacological therapies – offer diet and exercise counseling, cognitive stimulation, and training exercises.

History of prior donepezil use – ensure that the patient has been on donepezil 10 mg/day for at least 3 months. Assess history of side effects with donepezil – nausea, vomiting, weight loss, and anorexia.

Consider stepwise escalation of donepezil to 23 mg/day. Monitor side effects.

At all stages, maintain open communication channels with the patient and caregivers. Set realistic expectations from treatment, in a language that is meaningful, emphasizing real-life benefits and observable outcomes in the everyday life of the patient, the family, and the caregiver.