INTRODUCTION

ARICEP M is a combination of Donepezil and Memantine which belongs to the group of medicines called Acetylcholinesterase inhibitors and NMDA receptor antagonists respectively. It is used to treat moderate to severe dementia caused due to Alzheimer’s disease (Alzheimer’s type dementia) in patients previously treated with donepezil alone. Alzheimer’s type dementia is a type of brain disease where the dementia (disorder of thoughts, memory, and behaviour) happens due to degeneration of brain cells that carry memories.

Donepezil is an acetylcholinesterase inhibitor. It acts by restoring the levels of a brain chemical called acetylcholine that carries messages within the nerve cells. Memantine is a NMDA receptor antagonist. It acts by suppressing the overactivation of certain brain chemicals (glutamate) that damages the nerve cells. Together, they help in reducing the symptoms of Alzheimer’s type dementia.

Before taking ARICEP M inform your doctor if you have any liver, kidney, or heart problems. You must also inform your doctor if you have any stomach problems (ulcer or bleeding in the gut), breathing problems (asthma), bladder problems, epilepsy or are severely dehydrated due to excessive sweating, vomiting or diarrhea.

Consult your doctor before taking ARICEP M if you are pregnant or breastfeeding. ARICEP M may cause nausea and vomiting during the initial days of therapy. These side effects are unusually temporary and disappears as your body gets used to ARICEP M. However, consult your doctor if they worsen. Other most common side effects of taking ARICEP M are headache, dizziness, and loss of appetite.

USES OF ARICEP M

• Treats moderate to severe Alzheimer’s type dementia

HOW ARICEP M WORKS

ARICEP M effectively controls the symptoms of dementia and Alzheimer’s disease by regulating the levels of certain chemical messengers (acetylcholine and glutamate) in the brain. Acetylcholine is a brain chemical which plays an important role in the functions of memory and cognition. Glutamate is another brain chemical that controls brain’s overall excitation. Overactivation of glutamate may cause damage to nerve cells. Alzheimer’s disease is usually characterized by decreased acetylcholine levels and increased glutamate levels in the brain.

ARICEP M contains two medicines, namely donepezil and memantine. Donepezil acts by restoring the levels of acetylcholine in the brain by blocking the actions of an enzyme called acetylcholinesterase which usually breaks down acetylcholine. Memantine acts by suppressing the overactivation of glutamate in the brain that causes nerve damage. Together, they restore the balance between chemical messengers in the brain, regulates proper transmission of nerve signals and reduces the symptoms of Alzheimer’s type dementia.

DIRECTIONS FOR USE

Take ARICEP M as directed by your physician. Swallow the medicine with a glass of water. Do not crush or chew the medicine. ARICEP M can be taken with or without food. Your doctor will decide the correct dose and duration of therapy for you depending upon your age, body weight and disease condition.

SIDE EFFECTS OF ARICEP M

HOW TO MANAGE SIDE EFFECTS

Nausea and Vomiting:

Take ARICEP M with or just after meals. Stick to simple meals. Avoid eating oil rich or spicy foods. Consult your doctor if your nausea worsens.

Diarrhea:

Hydrate yourself by drinking plenty of fluids, such as water or fruit juices. Consuming ORS can also be beneficial. Do not self-treat diarrhea on your own. Consult your doctor if your diarrhea becomes uncontrollable.

Headache:

Rest and relax. Keep yourself hydrated by drinking plenty of fluids such as water or electrolytes. Applying a pain-relieving balm on your forehead can be beneficial. Do not consume excessive alcohol, as it could aggravate your headache. Consult your doctor if your headache worsens.

Dizziness:

Try to rest and relax. Get enough sleep. Avoid driving or operating any tools or machines completely while you are feeling dizzy. Do not consume excessive alcohol, as it could aggravate your dizziness. Consult your doctor if your dizziness worsens.

WARNING & PRECAUTIONS

INTERACTIONS

A. Drug-Drug Interaction:

Before taking ARICEP M inform your doctor if you are taking any of the following:

• carbonic anhydrase inhibitors (used to reduce edema) such as acetazolamide, methazolamide
• sodium bicarbonate (used to treat metabolic acidosis)
• non-steroidal anti-inflammatory drugs (used for pain relief) Ex. aspirin, ibuprofen, naproxen
• diuretics or water pills (used to treat edema and hypertension) Ex. furosemide, chlorothiazide
• marijuana (a psychostimulant drug that causes addiction)
• anesthesia (used before surgeries to cause numbness) Ex. lignocaine, bupivacaine, isoflurane, sevoflurane

Overdosage:

If you or anyone else took ARICEP M excessively, contact your doctor immediately or go to a nearby hospital straight away. Symptoms of overdosage might include passing out or trouble breathing, severe nausea or vomiting, excessive sweating, very slow heartbeat, slow or shallow breathing, seizures, restlessness, hallucinations, and loss of consciousness.

SYNOPSIS

MORE INFORMATION

• Keep ARICEP M out of reach of children
• Store ARICEP M at room temperature

FAQs ABOUT ARICEP M

How and when should I take ARICEP M?

ARICEP M is taken preferably after meals either in the morning or at night before going to bed. However, your doctor will decide the time of administration and number of doses to be taken per day based on your age, body weight and disease condition. Swallow the medicine with a glass of water. Do not crush or chew the medicine.

What if I forget to take a dose of ARICEP M?

If you forget to take a dose of ARICEP M, take it as soon as you remember. However, if it is time to take the next dose, skip the missed dose and take the next one at regular times. Do not take a double dose of ARICEP M to compensate a missed dose, as it could lead to toxicity.

What precautions do I need to follow while taking ARICEP M?

Before taking ARICEP M, inform your doctor if you have any liver, kidney, or heart problems. You must also inform your doctor if you have bleeding in the stomach, asthma, or fits. Consult your doctor before taking ARICEP M if you are pregnant or think you may be pregnant or breastfeeding.

Can the use of ARICEP M cause headache?

Yes. ARICEP M may cause headache in some individuals. This side effect is unusually temporary and disappears as your body gets used to ARICEP M. However, consult your doctor if they become uncontrollable to manage.

Can I stop taking ARICEP M once my symptoms subside?

Do not stop taking ARICEP M without consulting your doctor, as it may make your symptoms to reappear. If you feel that your symptoms subside after taking ARICEP M, consult your doctor for advice. Your doctor will access your health condition and gradually reduce the dose of ARICEP M before complete cessation.

Can ARICEP M cause vomiting?

Yes. ARICEP M may cause vomiting in some individuals. This side effect is unusually temporary and disappears as your body gets used to ARICEP M. Meanwhile, get adequate rest. Drink plenty of fluids to keep yourself hydrated. Avoid eating oil rich spicy foods. Stick to simple meals. However, consult your doctor if they become uncontrollable to manage.

What does ARICEP M do?

ARICEP M effectively controls the symptoms of dementia and Alzheimer’s disease by regulating the levels of certain chemical messengers (acetylcholine and glutamate) in the brain. It restores the balance between chemical messengers in the brain, regulates proper transmission of nerve signals and reduces the symptoms of Alzheimer’s type dementia.

Is it safe to take ARICEP M ?

Yes. ARICEP M is generally safe when taken at the doses prescribed by the physician. However, it may cause few minor side effects like nausea, vomiting, diarrhea, weak muscle, headache, dizziness. These side effects are unusually temporary and disappears as your body gets used to ARICEP M. However, consult your doctor if they become uncontrollable to manage.

Does ARICEP M improve cognition?

Yes. ARICEP M improves cognition in people suffering from mental illness like dementia. It controls the symptoms of dementia by increasing the levels of a chemical messenger (acetylcholine) in the brain which plays an important role in the functions of memory and cognition. As a result, it improves memory and reduce the unpleasant symptoms of dementia.

Can I take paracetamol along with ARICEP M?

Avoid concomitant use of NSAIDS like paracetamol or ibuprofen while taking ARICEP M, because it may increase the risk of bleeding. Consult your doctor for an alternative pain relief medicine.

Can ARICEP M be used in elderly patients?

Yes. ARICEP M should be used with caution in elderly patients (aged 65 years and above). Therefore, consult your doctor before taking it. Proper dose adjustment and careful monitoring are required in such patients.

Can ARICEP M cause diarrhea?

Yes. ARICEP M may cause diarrhea in some individuals. If you experience diarrhea, hydrate yourself by drinking plenty of fluids, such as water or fruit juices. Consuming ORS can also be beneficial. Do not self-treat diarrhea on your own. Consult your doctor if your diarrhea becomes uncontrollable.

REFERENCES

1. KD. Tripathi. CNS Stimulants and Cognition Enhancers. Essentials of medical pharmacology. Seventh edition. 2013. Page – 490.

2. Rob Jones 1, Bart Sheehan, Patrick Phillips, Ed Juszczak, Jessica Adams, Ashley Baldwin, Clive Ballard, Sube Banerjee, Bob Barber, Peter Bentham, Richard Brown, Alistair Burns, Tom Dening, David Findlay, Richard Gray, Mary Griffin, Clive Holmes, Alan Hughes, Robin Jacoby, Tony Johnson, Roy Jones, Martin Knapp, James Lindesay, Ian McKeith, Rupert McShane, Ajay Macharouthu, John O'Brien, Caroline Onions, Peter Passmore, James Raftery, Craig Ritchie, Rob Howard, DOMINO-AD team. DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease - a multicentre RCT. NIH: National Library of Medicine, National center of biotechnology Information Pubmed.gov. July 2009. [Accessed on 30th Mar 2022] https://pubmed.ncbi.nlm.nih.gov/19630974/

3. Amneal Pharmaceuticals. [Revised on Oct 2016] [Accessed on 30th Mar 2022] https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2335950c-be3b-4248-ad04-e9763aee47d2