This class of medication (e.g. Donepezil and Rivastigmine) should initially be prescribed by those clinicians who have sound experience in treating #Parkinson’s disease or #dementia. At the outset, a low dose of medication should be used to assess #patient response and minimise the chance of side effects. Typically, the starting dose for #Donepezil 5 mg each day and that of #Rivastigmine is 1.5 mg twice each day (i.e. every 12 hours). Over time, for instance 2 – 4 weeks, the dose may be titrated up to achieve the optimal therapeutic effect.

These medicines are normally #prescribed as either #tablets, #capsules or as a #liquid. Also, Rivastigmine is available as a #patch to aid with #compliance and support those with swallowing difficulties. It is recommended that Donepezil be taken at night prior to going to sleep. However, it may be that the patient reports intense dreams and if this is the case then the medication can be switched to a morning dose.

With regards to patient / carer advice, it is important to outline that this class of medication can slow the rate of neurological decline and can indeed enhance memory / brain function. However, the prescribing or dispensing clinician should state that revival of #brain function is modest and that the medicines do not present as a cure for the diagnosed condition(s). It is important to talk through commonly presenting side effects with Donepezil and Rivastigmine and underscore that these may fade over time. The General Practitioner (#GP) should be made aware of any abnormal movements or aggressive behaviour. In this case, it might be that the adverse events may reverse on dose reduction or treatment cessation (i.e. with another suitable medication to replace the therapy).

Clearly, #patient assessment is important following the commencement of this type of medication. Here, a typical timeline for such review would be 2 -4 weeks following initiation; this could either be for initial treatment assessment or any necessary dose adjustments. In order to probe the benefits of treatment, a clinical evaluation should take place at three months following initiation or dose adjustment. It is important to evaluate the impact of treatment because if no meaningful improvement is seen (i.e. improved behavioural, functional or cognitive function) then the medication should be stopped. If this is the case, then the patient and relatives / carers should be consulted accordingly.

There are a range of medicinal forms of Donepezil and Rivastigmine within the United Kingdom and beyond. At this present moment in time, there are no significant differences in these agents with respect to cost or treatment efficiency. When prescribing, the agent with the lowest cost should be selected with concurrent reference to national / local guidelines plus references sources such as the British National Formulary (#BNF).

#clinical #pharmacy #patientcare #counselling #medicine #medicines #student #uni #universty #psa #prescribingsafetyassessment