Warfarin and Aricept

[mia]

Hi everyone
Haven't posted here for a while. Thanks to previous messages and your kind advice, have done alot to help my dad. He has been diagnosed with AD, we have had 1 appointment with consultant and 1 today at memory clinic.

Dads memory scores were quite good today and in fact better than in January - strangely. My question is that the first consultant he saw said he would not give Dad aricept due to risks associated with Warfarin - Dad has got an irregular heartbeat - never had a heart attack and the Warfarin, aspirin have kept him stable for years. We told consultant we are not happy with decision without knowing risks etc, hence he referred him to memory clinic I think.

Today when we went consultant wasnt there so we could not talk to him. They want to do blood tests now and dad has already had an ECG which memory clinic have results of. Our next appointment is 6 weeks with consultant and to discuss results etc. Has anyone here got family experience of taking Aricept and Warfarin. We are just suprised that at first it was a point blank No to the drug and now we have been referred to another consultant at memory clinic. Should we fight for the drug, does anyone know of any risks etc.
I am so grateful for this forum
Thankyou

 

[Nebiroth]

There is another thread on here with another posting about how Reminyl (a drug very closely related to Aricept) is thought to have caused a slow heartbeat in a relative and that the drug has been stopped.

I think it unlikely that Aricept will be prescribed if it is thought to present a risk to someone with a pre-existing condition. This is not least because, due to the individual reactions to it, there may be no benefit. It is not possible to predict this...however, the best that can be expected is a slight and temporary improvement.

Also, if you Dad is scoring relatively well on the tests he may not fall into the group for which the NICE guidelines recommend prescription. These are not absolute rules, a clinician can still prescribe if they feel it serves the best interest of their patient, but they may be called on to justify it to the Primary Care Trust.

This, plus the existing heart condition, may explain the reluctance.

 

[jenniferpa]

I would want clarification about whether the aricept is contraindicated because of the warfarin or because of the underlying heart condition.

 

[mia]

Thanks for your replies, he scored 22 out of 30 today and 17 out of 30 last time - but days are so changeable I know. Do you know if that is within the Nice guidelines. The risk is due to the heart condition we believe. We need more information I think, always so many questions that not thought of at the time...
thanks again for your help.

 

[Countryboy]

Hi I have been taking Aricept since Nov 1999 No problems what so ever

 

[jenniferpa]

Mia - the manufacturers handout for aricept indicates the following

Formal pharmacokinetic studies evaluated the potential of ARICEPT® for interaction with theophylline, cimetidine, warfarin, digoxin and ketoconazole. No effects of ARICEPT® on the pharmacokinetics of these drugs were observed.

So it's really down to the underlying disease. The real issue will be one of "is it safe to prescribe". However when it come to score on the MMSE nice guidance says it should be between 10 and 20 points, although that isn't the only thing that should be considered.

 

[mia]

Thanks Jennifer, great to have so many people here who know so much.
take care

 

[Sam Iam]

Mia,
Mum was put on Aricept on December and she is on Warfarin.
I had no idea of the potential for an interaction between the two (thanks Jenniferpa).
Mum was commenced on Aricept after her Atenalol was adjusted to raise her pulse to 65ish but mum's pulse rate dropped to 51 and her MMSE dropped by 4 points so the Aricept was stopped 3/4 weeks ago

 

[mia]

Thank you all very much.........xx

 

[shelagh]

Hi, I have been on Warfarin for 24 years following a series of episodes of PE. There was a query about my taking Aricept originally and I had to have heart traces etc which showed what I already knew that I have left heart enlargement. On balance it was decided I would benefit from Aricept and I have now been taking first Aricept and nowe Exelon for 19 months with no problems, It depens on the consulatant I think and the GP's input
Good luck
Shelagh

 

[Haydar]

Dear Mia,
Warfarin is not a drug used for treatment of heart problems. It only helps to keep blood flowing smoothly in your body by decreasing the amount of clotting proteins in the blood. Warfarin is sometimes commonly referred to as a "blood thinner". However its more correct term is "anticoagulant." Conditions which increase your risk of developing blood clots include a certain type of irregular heart rhythm heart valve replacement, or a recent heart attack. Preventing harmful blood clots helps to reduce the risk of a stroke or heart attack. Aricept (donepezil) is not included in Warfarin?s interacted drugs list.

In the side effects of Aricept (donepezil) slow/irregular heartbeat is listed as not common but as serious side effect.

References:
1- http://www.medicinenet.com/warfarin-oral/article.htm
2- http://www.medicinenet.com/donepezil-oral/article.htm

Conclusion: If someone already has slow/irregular heartbeats then it may be appropriate not to use Aricept. But not appropriate for the only reason because that person is on Warfarin.

Important: What I wrote in Conclusion is my personal thinking after reading referenced articles. Therefore should not be considered as a medical advice.
________

 

[Nels]

My mother has been on warfarin for about 10 years, this was prescribed for clots in her lungs. She has been on Aricept for several years. She also has a pacemaker as she went into heart block about 11 years ago. When diagnosed with Az she has to undergo tests on her heart and her pacemaker before being prescribed Aricpet.

As the previous poster stated Warfarin is not prescribed for heart conditions.