Talk:Donepezil

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This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Cngiese SOP8. Peer reviewers: CP133 AF G7, Hocar7, 7jmv.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 19:43, 16 January 2022 (UTC)

NICE guidlines
the bit about NICE guidlines stating donepezil can't be used in mild dimentia is wrong or has been superseded by more recent guidelines, http://www.nice.org.uk/guidance/index.jsp?action=byID&o=13419. if someone could ammend the page that would be grand. thanks. — Preceding unsigned comment added by 213.123.9.85 (talk) 17:00, 4 January 2012 (UTC)

Yes, I noticed that, but hesitated to change it. (it has dramatically helped my mom, so for that reason, I am more cautious to edit, not wanting to post "personal experience".) ( Martin | talk • contribs 19:22, 18 December 2012 (UTC))

ADHD, non-alzheimers cognitive disruptions, apathy
I know that this drug is prescribed off label for ADHD, with some study backing particularly for executive functioning, and also for non-alzheimers related cognitive complaints, including relating to mood disorders. Galantamine (another anticholinesterase inhibitor) has been studied to treat the negative symptoms of schizophrenia, and a study was in progress for compulsive hoarding at UCLA (haven't seen it yet, i hope it hasnt been abandoned.) These types of medications have also been looked at for treating apathy, and not simply in neurodegenerative and depression related cases.

I was wondering if anyone else shares interest in covering the promising possible applications for the drug. I know that there was talk that Aricept was even being submitted to the FDA for treatment approval ADHD at one point. It looks very promising and warrants mention. I was wondering if anyone else has knowlege and wants to help. I can hunt back for the links and such. 69.196.227.59 05:35, 1 July 2006 (UTC)

Wikipedia is not a place for original research, speculation or potential uses. Use your favorite search engine and pubmed for that. Slicky 10:00, 14 January 2007 (UTC)
 * Wait a minute here. Please assume good faith. To me, it seemed the above user was merely wanting to find reliable sources that talked about what he had previously heard. If what he says is true, and reliable sources saying it could be found, it would merit mentioning in the article and certainly would not be original research.--Gloriamarie 19:50, 26 September 2007 (UTC)

One off label use includes ameliorating memory impairment caused by some antidepressents. (Anecdote: it helped but had significant side effects.)

At least some physicians regularly prescribe off label doses of 15 mg / day. 64.26.98.90 (talk) 00:27, 24 July 2008 (UTC)

formula
is it tertiary or qaternary? —Preceding unsigned comment added by 41.233.139.219 (talk) 22:42, 30 October 2007 (UTC)

Merge proposal
There is an article called Donezepil which seems to be largely identical with this one. Donezepil should simply be a redirect to this page. --ἀνυπόδητος (talk) 19:46, 16 August 2008 (UTC)


 * I went ahead and did it. If the creator was correct, then the other page is unnecessary; if he was incorrect, we'll find out sometime, and that page would still need to be cut down. :) II  | (t - c) 09:41, 17 August 2008 (UTC)

What approvals
Article is not clear on FDA, EU and other approvals for AD or other indications. Rod57 (talk) 09:59, 16 April 2011 (UTC)

Adverse events
Hi Jayanta,

When a clinical trial is run, there is usually a placebo group so that you can tell what effect the drug is having. If you give people with cancer a drug and they live 8 months, you can't just conclude that the drug extended their lives by that amount. You have to have a placebo group and see how long people lived without the drug. If people in the placebo arm live 5 months, the effect attributable to the drug is not 8 months but 3. Its the same with adverse effects. Some people will have headaches in every day life, one can't blame headaches that people would have had anyway on the drug. So you compare the rate of adverse effects to that in the placebo group, as the FDA does in the drug package insert. The adverse effect rates in the paper you cited seem very high relative to what I see in the package insert and the very common statement that "donepezil is generally well tolerated" that I see in many different sources, and they are not compared to rates in the placebo group.

Some other reviews include: http://www.ncbi.nlm.nih.gov/pubmed/17939763 http://www.ncbi.nlm.nih.gov/pubmed/19270633 http://www.ncbi.nlm.nih.gov/pubmed/16863459 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001190.pub2/abstract

The other issue I had with that source is that 45% "body effects" is difficult to understand. Exactly what is a body effect? Its too vague to be meaningful.

Finally, your last reversion "please do not remove properly sourced material without explaining first on the Talk page" has Wikipedia policy backwards. Per WP:NOCONSENSUS, "In discussions of proposals to add, modify or remove material in articles, a lack of consensus commonly results in retaining the version of the article as it was prior to the proposal or bold edit." Formerly 98 (talk) 23:18, 15 January 2015 (UTC)
 * What content are we proposing to add. Doc James  (talk · contribs · email) 23:48, 15 January 2015 (UTC)
 * Diff I don't know what "Body Effects" are and the rates seem way too high to be adverse drug effects rather than AEs (though described by the source as the former, they seem out of sync with other sources). Formerly 98 (talk) 23:49, 15 January 2015 (UTC)


 * Jayanta inserted, and edit-warred to retain, the following:


 * On average, 10% to 70% of patients show adverse drug reactions (ADRs) depending upon type and severity of the ADRs. The most frequent ADRs include body events (45%), cardiovascular problems (18%), alterations in the digestive system (34%), hematic and lymphatic alterations (5%), metabolic and nutritional changes (6%), musculoskeletal problems (17%), complications in the respiratory system (22%), skin and appendages (14%), special senses (5%), urogenital (24%), and CNS (52%) (agitation, insomnia, confusion, depression, anxiety, dizziness, vertigo, headache, restlessness, hallucinations).


 * That source is not classified as a review by Pubmed nor by MEDLINE. I removed the content because of that.  I found a recent review that backed up what was already in the article (it cites the most recent Cochrane review, which is quite old). Jytdog (talk) 23:51, 15 January 2015 (UTC)

1) The meaning of a placebo is commonly known. However, the absence of the impact of a placebo in a research does not make the information unimportant. If 50% of smokers are found to develop lung cancer, then that is still important information even if there were no group of non-smokers given a placebo to compare with. The information that Donepezil use is associated with CNS (agitation, insomnia, confusion, depression, anxiety, dizziness, vertigo, headache, restlessness, hallucinations) in 52% is important information. If you go to WP:MEDRS, you will find no mention of a requirement for placebo data.

2) Formerly is misinterpreting WP:NOCONSENSUS. Not having consensus does not mean that pertinent information from a RS can be removed.

3) The article in "Neuropsychiatric Disease and Treatment" that I cited qualifies as a secondary source according to Wiki policy, even though it may not appear as a "review" in MEDLINE.

4) "Neuropsychiatric Disease and Treatment" is a reliable source. It's associate editor is Professor Tang, Department of Psychiatry, the Chinese University of Hong Kong. Its articles are peer reviewed. Its honorary editorial board has professors from many well known universities worldwide.

5) The fact that 52% patients have CNS problems is important. If you have a better source for CNS problems from Donezepil, then include it. Otherwise this information should be restored. In the absence of a consensus the alternative would be to RfC, followed by other resolution procedures.

Best,

JS (talk) 22:34, 16 January 2015 (UTC)


 * The source cited by Jayanta is here (free PMC) and is . It is 8 years old. Our article now cites a review from 2014; there is no reason under MEDRS or any policy or guideline for citing an older review when a newer one is available. Do you see that Jayanta? Please do read WP:MEDRS on this point, in particular, WP:MEDDATE. Thanks. Jytdog (talk) 22:40, 16 January 2015 (UTC)
 * quite separately, the author of the 2008 cites "table 3" for the detailed listing of adverse events - it is here. There is no 45% or 52% figure there.  I am guessing the author must have added up individual ADRs to lump them into "body" or "CNS", as though they occur independently, which is... a very nonstandard way to go. They don't occur independently - they overlap all the time.  Those bizarre summary numbers should not be in the article.  It is not true that 52% of people have CNS problems. It is important that we do not include that in the article. Jytdog (talk) 22:55, 16 January 2015 (UTC)


 * Again, there is no Wiki policy that says an "article is too old". Similarly, though Jytdog may have expertise, his criticism of the "nonstandard way to go" is OR. The question is whether "Neuropsychiatric Disease and Treatment" meets Wiki's requirements. The total absence in this article of any mention of mania caused by Donezepil which has been mentioned in numerous primary sources, and also in a secondary source is inappropriate. Again, I do not have a lot of time to spend arguing this, and if we are not able to come to a resolution, then I will proceed to RfC etc. JS (talk) 23:09, 16 January 2015 (UTC)


 * Please read WP:MEDDATE, which is part of the MEDRS guideline and it is clear as day that we use recent sources. You cannot just blow off guidelines; you need to provide a reason. Jytdog (talk) 23:40, 16 January 2015 (UTC)


 * I did a search in Pubmed for "Donepezil mania" with the review filter on and got five results; none of them discuss mania as an adverse event. The FDA label doesn't mention it, nor does the 2014 review. And in indeed  - one of the five sources that came up in the review, says:
 * "'Donepezil as well as other acetylcholinesterase inhibitors appear to have effects on human mood and behavior. Recent years have witnessed a growing number of preliminary observations with the newly introduced orally administered forms of cholinesterase inhibitors. ...Specifically, studies suggest that cholinesterase inhibitors may be useful in the diagnosis of depression and personality disorders, and that they may have mood and behavioral normalizing effects on symptoms such as depression, mania, apathy, delusions, hallucinations, and delirium, in conditions such as bipolar disorder, schizophrenia, Tourette’s disorder, and delirium. Donepezil was involved in the largest number of studies and was associated with the largest number of positive results."
 * So I really don't know where you are coming from. Jytdog (talk) 23:49, 16 January 2015 (UTC)


 * JS, you are right that a controlled clinical trial of smoking is not needed, nor is one needed for jumping out of airplanes with or without a parachute. Smokers get cancer at 15 times the rate of non-smokers; the effect size is so large as to render the need to for a well-matched control group moot.  Similarly, 100% of people who fall from the sky without parachutes die, while 99.9% of those who use parachutes live.  A control group is not needed.  But when you start talking about CNS and psychiatric effects among people with AD, the rate of adverse events is quite high in the absence of drug treatment.  You need that comparison if you want to sort out what fraction of confusion is due to disease and what is a side effect of the drug.  What the author of this paper has done is equivalent to finding that 30% of people with cancer treated with a chemotherapy drug have bone pain.  Bone pain is well-known as an effect of cancer, and it would be foolish to simply attribute pain in every treated patient who has it to the drug.


 * The review you have added is out of sync with the mainstream literature, and it will simply confuse people. Formerly 98 (talk) 23:57, 16 January 2015 (UTC)

This is typically a good source  Doc James  (talk · contribs · email) 02:16, 17 January 2015 (UTC)
 * The ref in question says "On average, side-effects in donepezil trials account for 20%–60% of dropouts and are present in 10%–70% of the patients depending upon type and severity of the ADRs. Side-effects and ADRs associated with donepezil can be classified in two main categories: common side-effects, most of them observed in clinical trials with AD patients, and unfrequent or extraordinary side-effects, seen in especial conditions or in small clusters of patients with different pathologies under treatment with other concomitant drugs. The most frequent ADRs (Table 3) occurring in more than 5% of patients treated with donepezil include body events (45%), cardiovascular problems (18%), alterations in the digestive system (34%), hematic and lymphatic alterations (5%), metabolic and nutritional changes (6%), musculoskeletal problems (17%), complications in the respiratory system (22%), skin and appendages (14%), special senses (5%), urogenital (24%), and CNS (52%) (agitation, insomnia, confusion, depression, anxiety, dizziness, vertigo, headache, restlessness, hallucinations)"
 * They must not be taking into account the rate that occurs with placebo which if this is the case poor form. Doc James  (talk · contribs · email) 02:23, 17 January 2015 (UTC)

I understand the objections that are being made about including information about Donepezil induced CNS problems, but I do not believe they are valid

1) Drugs.com is not a "good source" for Wiki's purposes. It is a commercial site supported by advertisements and information there is not peer-reviewed.

2) Whereas recent sources are to be preferred for Wiki, however it does not imply a 2007 paper is too old. Also a more recent review which does not mention mania is not the same as a review that says Donepezil does not induce mania.

3) Again, "poor form" is OR. We need to respect RS.

4) "Neuropsychiatric Disease and Treatment" meets and exceeds Wiki's requirements. Check the list of professors associated with this journal.

5) Whereas Donepezil "may have mood and behavioral normalizing effects on symptoms such as depression, mania", this does not imply that the information in other papers that find it induces mania is incorrect. If you wish to include information about the beneficial effect of Denepezil, you are welcome to do so with proper cites. However, other information from proper sources should also be included.

6) We are not to judge whether included information will "confuse the reader". Our job is to include relevant information in an understandable encyclopedic manner.

JS (talk) 04:58, 17 January 2015 (UTC)
 * you are ignoring WP:MEDDATE. There is no justification for including an old source when newer ones are available. Jytdog (talk) 06:15, 17 January 2015 (UTC)


 * Well ,


 * 1) The FDA package insert places the rates of AEs very differently from your review. Your 18% cardiovascular problems becomes 2% per the FDA.  Your 22% respiratory problems becomes 0%.  Your 14% skin and appendeges problems becomes 3%.  Your 24% urogenital problems becomes 2%.  Your 52% CNS problems becomes 26%.  And this is WITHOUT subtracting AEs in the placebo group.
 * 2) Disagree. Mania is an important enough AE that failure to mention it in a review article suggests it was not seen. Are you suggesting that review articles routinely give a comprehensive listing of AEs that were not seen?  That's certainly outside my experience.
 * 4) The fact that you have a source for something is necessary but not sufficient to add it to the article. You need consensus that its addition improves the article, and you clearly do not have that here.
 * 6) Disagree entirely. The purpose of an encylopedia is to inform.


 * But all these points aside, you've come here as someone with little to no experience in editing medical articles, and have tried to edit war into place material that is opposed by three editors who spend 70% or more of their time on medical content. We've explained our concerns to you but you seem more concerned with what you perceive as your "right" to add material to this article than listening to others who have more experience than yourself with medical subject matter.  At this point, instead of engaging in further WP:REHASH I'd suggest that you let it go. You can't add this material without concensus, and three editors have explained their opposition and the basis of their concerns to you. Formerly 98 (talk) 10:41, 17 January 2015 (UTC)

Formerly, as you have brought personal qualifications into the discussion, I have to note that I edit under my real name. My professional affiliations, conflicts of interest etc. are easily available on the Internet. Can you do the same? Also, when an editor mentions drugs.com as a good source for information, I am not overly impressed. The point remains simple. Donepezil has been said to cause multiple problems in a secondary source peer reviewed article. This information is important for readers. Currently this information is absent in the article, and as it has not been restored I will ask for a RfC. JS (talk) 02:27, 19 January 2015 (UTC)
 * You still haven't dealt with WP:MEDDATE, nor with the fact that both older and more recent reviews don't report anything like what is in that review. You are putting WP:UNDUE weight on one outdated and outlying source - what you are doing is classic cherry-picking.   Your RfC will fail but you are of course free to try. Jytdog (talk) 03:53, 19 January 2015 (UTC)

Talk about reliability of drugs.com: https://en.wikipedia.org/wiki/Talk:Drugs.com

ee1518 (talk) 06:42, 6 November 2017 (UTC)

Autistic?
What does this article mean by autism? Classical autism or the overall autism spectrum? Ms. Andrea Carter here (at your service &#124; my evil deads) 01:06, 26 July 2015 (UTC)

11/3/15 changes our group made
Improved lead section, added more appropriate secondary literature references Added to the adverse effects and contraindication sections, along with references. Included more rare but serious side effects, rather than just the most common GI effects. — Preceding unsigned comment added by Cngiese SOP8 (talk • contribs) 00:17, 7 November 2015 (UTC)
 * Great job! Here is our peer review by Group 7. The first sentence of lead section has a typo. In the Medical Uses section, it would be helpful to note that the US FDA approved donepezil for mild, moderate, and severe dementia in Alzheimer's, rather than just severe dementia. In the Adverse Effects section, some of the sentences need references, and adding in the frequencies for each of the mentioned adverse effects would be helpful. The first sentence of the contraindications section needs a citation. It might also be confusing for a normal person to look at the contraindications section and see the "caution populations," as this is not a formal contraindication.7jmv (talk) 06:07, 9 November 2015 (UTC)

11/9 Final Draft Edits - Group 8
- Renamed the "Contraindications" section to "Warnings and Precautions" to better reflect the content (cautionary details about the drug). Also rearranged some statements in that section to better organize the information. - Added citation to the first sentence in the Warnings and Precaution section - Edited the medical uses section to specify the FDA indication was approved for "dementia" in "Alzheimer patients." - Corrected the typo in the lead sentence - Incidence of adverse effects were not included because that information was found mainly in primary literature, a source we did not want to reference due to the nature of Wiki. Instead, we discussed common side effects and separated them from more rare and serious side effects. — Preceding unsigned comment added by YykimSOP 8 (talk • contribs) 22:27, 9 November 2015 (UTC)

Needs discussion
Commented here Talk:Suvorexant Doc James  (talk · contribs · email) 06:52, 10 November 2015 (UTC)

What do you mean by Suvorexant? I did not see Donepezil mentioned there! https://en.wikipedia.org/wiki/Suvorexant ee1518 (talk)

As treatment for alcoholism brain damage
Article in R&D magazine online at https://www.rdmag.com/news/2018/02/alzheimers-drug-repairs-brain-damage-after-alcohol-binges-rodents?et_cid=6264661&et_rid=612267395&type=cta&et_cid=6264661&et_rid=612267395&linkid=content "In a study led by Duke Health and published in the journal Alcoholism: Clinical and Experimental Research, scientists demonstrate in rats that a short duration of the drug donepezil can reverse both structural and genetic damage that bouts of alcohol use causes in neurons, or nerve cells, in the young brain." senior author Scott Swartzwelder, Ph.D., professor in psychiatry at Duke 96.69.194.115 (talk) 20:58, 16 February 2018 (UTC)

Donepezil
User:Exert yourself has attempted to present donepezil as an accepted treatment rather than early stage research in ADHD and autism. Have moved to the research section. These are not accepted uses.

The source is page 369 here. Doc James  (talk · contribs · email) 09:05, 26 July 2019 (UTC)


 * The ref supports its use. A broad of experts believe those trials you thought low quality are fair enough to make conclusion. More importantly, I am not citing open trials. Rather, I am citing the latest medical textbook based on WP:RMEDS. --Exert yourself (talk) 09:09, 26 July 2019 (UTC)
 * My stance is clear. Here is the Wikipedia, not a peer-review discussion board. Per WP:RMEDS, the latest medical textbook is deemed to be the highest level evidence that can be used on Wikipedia's medical articles. --Exert yourself (talk) 09:17, 26 July 2019 (UTC)
 * Per this these are not approved uses in the US. Additionally the dual use of donepezil and memantidine is not recommended by NICE in the UK (which the source you used says).  Doc James  (talk · contribs · email) 09:25, 26 July 2019 (UTC)
 * Sir, I explained here in my talk page (User_talk:Exert_yourself).--Exert yourself (talk) 10:58, 26 July 2019 (UTC)
 * However, the latest systematic review doesn't support your evidence. --Exert yourself (talk) 09:33, 26 July 2019 (UTC)
 * By the way, your modification is not the refs say. Per WP:RMEDS, we should use the latest evidence and the older evidence doesn't supersede the newer. --Exert yourself (talk) 09:33, 26 July 2019 (UTC)

I have to side with doc james on this one. The analysis of Donepezil in the provided source appears superficial. I would afford this book no weight, and also mention that it was written by pharmacists, whom I would suggest are not quite the experts we are looking for anyway. Someguy1221 (talk) 09:44, 26 July 2019 (UTC)
 * also agree w/ Doc James, book in question has no weight--Ozzie10aaaa (talk) 10:53, 26 July 2019 (UTC)


 * Sir, I explained here in my talk page (User_talk:Exert_yourself) --Exert yourself (talk) 11:01, 26 July 2019 (UTC)


 * I think people can provide another evidence to state them together rather than just kicking the ref out of the sight.--Exert yourself (talk) 09:55, 26 July 2019 (UTC)


 * The ref is useless, though. The whole point of using secondary and tertiary sources is to get commentary and analysis of primary sources from independent experts. This book doesn't do that. It just lists a few studies and a case report of donepezil use and gives a brief summary. This is nominally a tertiary source, but in reality, insofar as this drug is concerned, it's nothing. Someguy1221 (talk) 10:35, 26 July 2019 (UTC)


 * I think they probably had filtered out many studies before. This is the fourth edition. If the book is low quality, it should not have the chance to get the opportunity to release updates. --Exert yourself (talk) 10:39, 26 July 2019 (UTC)


 * I agree with Doc. Flyer22 Reborn (talk) 16:04, 26 July 2019 (UTC)


 * Also, WP:MEDDATE is clear that the reason editors should try to find newer sources is "to determine whether the expert opinion has changed since the older sources were written." We don't automatically give more weight to a newer source. Like WP:MEDDATE also states, "Assessing reviews may be difficult. While the most-recent reviews include later research results, this does not automatically give more weight to the most recent review (see recentism). Prefer recent reviews to older primary sources on the same topic. If recent reviews do not mention an older primary source, the older source is dubious. Conversely, an older primary source that is seminal, replicated, and often-cited may be mentioned in the main text in a context established by reviews. E.g., the article Genetics could mention Darwin's 1859 book On the Origin of Species as part of a discussion supported by recent reviews." Flyer22 Reborn (talk) 16:08, 26 July 2019 (UTC)