Therapy should be supervised by a physician experienced in the diagnosis and treatment of dementia in Alzheimer's disease. Therapy should only be started if the patient's caregiver monitors the patient's medication. Diagnosis of the disease should be carried out in accordance with current guidelines.
Tolerance and dose of the drug should be regularly assessed, mainly within three months after starting therapy. Then, the clinical efficacy of the drug and the tolerability of therapy should be regularly assessed in accordance with current clinical guidelines. Supportive therapy can be continued indefinitely if there is a therapeutic effect and the drug is well tolerated. The drug should be discontinued if the therapeutic effect is no longer observed or if the patient cannot tolerate treatment.
The drug is taken orally once a day, at the same time, regardless of food intake.
In order to reduce the risk of adverse reactions, the dose of the drug is titrated by gradually increasing it by 5 mg every week for the first three weeks:
1st week of therapy (1-7 days)
daily dose - 5 mg
2nd week of therapy (8-14 days)
daily dose - 10 mg
3rd week of therapy (15-21 days)
daily dose - 15 mg
4th week and beyond
daily dose - 20 mg
The maximum daily dose is 20 mg per day.
Recommended maintenance dose: 20 mg per day.
No dose adjustment is required in patients over 65 years of age.
Patients with impaired renal function
In patients with mild renal impairment (creatinine clearance (CC) 50-80 ml/min), dose adjustment is not required. In patients with moderate renal impairment (CC 30-49 ml/min), the recommended daily dose is 10 mg. If the drug is well tolerated for at least 7 days of treatment, the dose can be increased to 20 mg per day according to the standard titration scheme. In patients with severe renal failure (CC 5-29 ml/min), the daily dose should not exceed 10 mg.
Patients with impaired liver function
In patients with mild to moderate hepatic impairment (class A and B on the Child-Pugh scale), dose adjustment is not required. The drug is contraindicated in patients with severe hepatic impairment (class C on the Child-Pugh scale).
There are contraindications, consult with a specialist before use