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


CONCLUSIONS
Donepezil was frequently discontinued, and the rate of discontinuation was higher in patients with advanced dementia.
Umegaki
Hiroyuki
H
Department of Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan. umegaki@med.nagoya-u.ac.jp
Itoh
Akio
A
Suzuki
Yusuke
Y
Nabeshima
Toshitaka
T
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000077265:Donepezil; D005260:Female; D006801:Humans; D007189:Indans / Q000008:administration & dosage* / Q000009:adverse effects; D007564:Japan; D053208:Kaplan-Meier Estimate; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D011594:Psychometrics; D012189:Retrospective Studies; D016896:Treatment Outcome
D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil