Prescribing Off-Label Is Common
Donepezil (Aricept) is approved by the FDA for Alzheimer’s disease, and not for the treatment of mild memory loss. So what on earth was I doing prescribing this medication to Diane Pozniak, who had very mild memory loss by any definition, someone who clearly did not have any signs of dementia or Alzheimer’s disease? The answer to this seemingly loaded question is quite straightforward.
Although the FDA “labels” the use of a medication only for a specific disease or diseases, all licensed physicians are free to prescribe approved medications for other conditions if they wish to do so. Obviously, if something goes wrong and a lawsuit ensues, the physician will have a tough time explaining off-label prescribing in court. In reality, many physicians, particularly psychiatrists and neurologists, prescribe medications off-label. This is because there is a wide gap between patients’ needs and what the FDA has been willing to approve for a variety of brain disorders.
Donepezil (Aricept) for Mild Memory Loss
There are more and more people like Diane Pozniak who are taking donepezil (Aricept) for memory loss. Some, like Diane, have very mild symptoms that fall beneath most clinicians’ scanning radar, while others have more clear-cut symptoms that can be called mild to moderate memory loss without dementia. After all, if donepezil is successful in improving memory in a condition like Alzheimer’s that is horrendously difficult to treat, why shouldn’t it work as well, or even better, for milder forms of memory loss? As Diane’s story demonstrates, there is a place for donepezil in such a situation. In fact, recent studies suggest that it has a broad array of actions in improving memory: patients with
multiple sclerosis show improved memory on donepezil compared to placebo, and patients taking antidepressants and similar medications (some with known anticholinergic effects) report a subjective improvement in memory on donepezil. (There was no objective memory testing or placebo control in that study, so view the results with caution.)
Before you run off to get a prescription of donepezil (Aricept) from your doctor, it is important for you to understand exactly how cholinergic medications work; this will give you a sound basis on which to make your decision to take or not to take Aricept.
Science in Evolution: The Cholinergic Story
In 1976, Peter Davies, who was examining autopsied brains of patients with Alzheimer’s disease, reported the death of nerve cells that normally produced the neurotransmitter acetylcholine. Around the same time, David Drachman showed that administering scopolamine, which is an antagonist of acetylcholine, to normal people could produce memory impairment and other cognitive deficits that mimicked Alzheimer’s disease. These discoveries began the race to develop an effective medication that could reverse the acetylcholine deficit seen in patients with Alzheimer’s disease.
Taken From: The Memory Program How to Prevent Memory Loss
and Enhance Memory Power
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