Aricept vs. Adlarity for Alzheimer’s-Related Dementia by Alyssa Billingsley, PharmD and Joshua Murdock, PharmD

 

There’s no cure for Alzheimer’s disease. But medications are often used to help manage the symptoms. One commonly used medication is Aricept (donepezil).

Aricept is an oral medication used to treat all stages of Alzheimer’s-related dementia. It was first approved in 1996, and you can find it as a regular tablet and orally disintegrating tablet (ODT). Over 25 years later, the FDA approved Adlarity — a once-weekly patch version of donepezil. Now, people living with Alzheimer’s-related dementia have another option besides a daily pill.

So, how do donepezil tablets and patches compare? And is it worth making the switch? Keep reading to learn more about the key differences between Aricept and Adlarity. We’ll cover factors you may want to consider when discussing your options with your healthcare provider.

What is Aricept?

Aricept is a first-choice medication used to treat Alzheimer’s-related dementia. It’s approved for use in people with mild, moderate, and severe disease. Aricept is available as both a regular tablet and ODT. You can find it in three different strengths: 5 mg, 10 mg, and 23 mg (tablet only). Brand-name and lower-cost generic versions of the tablet are available. The ODT is only available as a generic.

What is Adlarity?

Adlarity (donepezil transdermal system) is a patch formulation of donepezil that’s used to treat Alzheimer’s-related dementia. Like donepezil tablets, it’s approved for use in people with mild, moderate, and severe disease. Adlarity is available as a once-weekly transdermal patch. You can find it in 5 mg/day and 10 mg/day strengths. It’s only available as a brand-name product.

How do Aricept and Adlarity work for Alzheimer’s-related dementia?

Aricept and Adlarity contain the same active medication: donepezil. Donepezil is an acetylcholinesterase inhibitor. It works by blocking an enzyme (protein) that breaks down acetylcholine in the brain.  Acetylcholine is a chemical that helps neurons in the brain communicate with each other. It’s involved in functions like memory, attention, and learning. People living with Alzheimer’s disease tend to have less acetylcholine in their brains. Donepezil works by making more acetylcholine available. Donepezil doesn’t treat the underlying disease process of Alzheimer’s. In other words, it doesn’t stop the condition from progressing. But it can help manage some of the cognitive and behavioral symptoms.

How are Aricept and Adlarity dosed and given?

While their dosing is similar, the instructions for taking Aricept and Adlarity are different. 

Aricept

Aricept is an oral medication taken by mouth once daily at bedtime. The tablets are swallowed whole. And the ODTs are dissolved on the tongue, followed by water. The tablets and ODTs are stored at controlled room temperature. For mild, moderate, and severe Alzheimer’s disease, the typical starting dose is 5 mg at bedtime. After at least 4 to 6 weeks of treatment, the dose may be raised to 10 mg once daily. 

The maximum dose for mild to moderate disease is 10 mg once daily. For moderate to severe disease, the dose may be raised to a maximum of 23 mg once daily. But this is only after taking the 10 mg dose for at least 3 months. Aricept is well-absorbed in your gut after you take it by mouth. And it takes about 15 days to reach a steady level of medication in your body.

Adlarity

Adlarity patches are designed to release either 5 mg or 10 mg per day over the course of 7 days. The starting dose is one 5 mg/day patch applied once weekly. Like the tablets, you may be switched to the 10 mg/day patch after about 4 to 6 weeks. But there’s no 23 mg/day patch option yet for people with moderate-to-severe disease.

It’s important to store and use Adlarity patches correctly. Keep them in the fridge until it’s less than 24 hours before you need to apply one. That’s because a patch needs to be used within 24 hours after it’s removed from the fridge. Don’t apply a cold patch — allow it to reach room temperature first.

You’ll keep the patch in place continuously for 7 days — even when bathing or taking a shower. It’s recommended to apply the patch to your back. But you can also apply it to your upper buttocks or upper outer thigh. Pick a specific day of the week to remove your old patch and apply a new one. Rotate application sites with each new patch. 

Adlarity patches may take a little longer to start working compared to the tablets. It usually takes about 22 days to reach a steady level of medication in your body. But the patches might be worth it if you have trouble swallowing pills or remembering to take them every day.

Switching from Aricept to Adlarity

Can you switch to patches if you’re currently taking the tablets? Short answer: It depends. You can make the switch if your daily tablet dose is available as a patch. So, patches would be an option if you’re taking 5 mg or 10 mg daily.

If you’re currently taking 5 mg by mouth daily, you can switch to the 5 mg/day patch. Similarly, you can switch to the 10 mg/day patch if you’ve been taking 10 mg by mouth daily. And if you’ve been taking the 5 mg dose for at least 4 to 6 weeks, you can switch to the 10 mg/day patch. 

How effective are Aricept and Adlarity for treating Alzheimer’s-related dementia?

Aricept is a first-choice medication for Alzheimer’s-related dementia. It has been shown to provide some benefit for people with mild, moderate, or severe disease. But more studies are needed looking at the benefits of long-term use. Adlarity has been shown to be bioequivalent to Aricept. That means you can expect a similar clinical benefit between the two. But as described above, it can take a bit longer for Adlarity to reach steady levels in your body.

What are the known side effects of Aricept and Adlarity?

Since Aricept and Adlarity contain the same active drug, they have many similar side effects. However, Aricept may cause more stomach-related side effects since it’s taken by mouth. But these tend to go away over time. Below are common side effects of both medications.

Side effect	Aricept	Adlarity
Nausea	11%	Undefined
Diarrhea	10%	4%
Headache	10%	15%
Insomnia	9%	7%
Pain	9% (various locations)	6% (abdominal pain)
Dizziness	8%	4%
Application site itching/irritation	Not applicable	6% to 9%
Muscle spasms/cramps	6%	9%
Constipation	Not reported	6%
Abnormal dreams	3%	4%

What are the serious side effects of Aricept and Adlarity?

Although rare, Aricept and Adlarity can cause serious side effects. Contact your healthcare provider right away if you notice or start experiencing the following:

·       Signs of a GI bleed like black/tarry stool and/or blood in your stool

·       Very slow heart rate

·       Pain when you pee or difficulty urinating

·       Seizures

·       Worsening chronic obstructive pulmonary disease (COPD) or asthma symptoms

Avoid prolonged exposure to heat (like saunas or excessive sunlight) while wearing the patch. That’s because it can cause your body to absorb too much medication. Overdose symptoms include severe nausea, vomiting, and sweating. Get medical attention right away if you think you’re experiencing an overdose.

What interactions do Aricept and Adlarity have?

Aricept and Adlarity can potentially make anticholinergic medications less effective. These are medications used to treat conditions like Parkinson’s disease, bladder disorders, and irritable bowel syndrome. Examples include dicyclomine, benztropine, and hyoscyamine. Both medications can also interact with certain medications used during anesthesia. If you’re scheduled for a surgical procedure, make sure your healthcare provider knows all medications you’re taking. Make sure your healthcare provider and pharmacist have your current medication list to check for potential interactions.

How much do Aricept and Adlarity cost?

Aricept is available as both brand-name and generic tablets. The average retail price for a 1-month supply of generic 10 mg tablets is about $117. And you can find it for as low as $7 at certain pharmacies with a free GoodRx discount. The generic ODT is about $13. Adlarity is only available as a brand-name product. We don’t know how much it’ll cost yet since that information hasn’t been announced. But we should know more in the coming months, since Adlarity is expected to launch early fall 2022.

The bottom line

Donepezil is now available as a tablet, ODT, and transdermal patch. When discussing your options with your healthcare provider, you’ll want to consider the pros and cons of each one. Aricept tablets and ODTs are available as lower-cost generic versions and can be stored at controlled room temperature. But you’ll need to remember to take them every day. And they can cause some bothersome side effects, especially when you’re first getting started.

If you have difficulty swallowing pills, the ODT or transdermal patch may be a good option. If taking medication every day is a hassle, the patch may be a more convenient option. But you’ll want to make sure you can follow the directions for storage and use.

References

Birks, J. S., et al. (2018). Donepezil for dementia due to Alzheimer's disease. Cochrane Database of Systematic Reviews.

Corium, Inc. (2022). Adlarity [package insert].

Corium, Inc. (2022). Corium receives FDA approval of ADLARITY® (donepezil transdermal system) for treatment of patients with Alzheimer's disease.

Ferreira-Vieira, T. H., et al. (2016). Alzheimer's disease: Targeting the cholinergic system. Current Neuropharmacology.

Kumar, A., et al. (2021). Donepezil. StatPearls.

National Institute on Aging. (2021). How Is Alzheimer's disease treated?

PD-Rx Pharmaceuticals, Inc. (2021). Aricept [package insert].

Winslow, B. T., et al. (2011). Treatment of Alzheimer disease. American Family Physician.

 from GoodRx Health