OVERDOSE
Because strategies for the management of overdose are
continually evolving, it is advisable to contact a Poison
Control Center to determine the latest recommendations
for the management of an overdose of any drug.
As in any case of overdose, general supportive measures
should be utilized. Overdosage with cholinesterase inhibitors
can result in cholinergic crisis characterized by severe
nausea, vomiting, salivation, sweating, bradycardia, hypotension,
respiratory depression, collapse and convulsions. Increasing
muscle weakness is a possibility and may result in death
if respiratory muscles are involved. Tertiary anticholinergics
such as atropine may be used as an antidote for ARICEPT™
overdosage. Intravenous atropine sulfate titrated to effect
is recommended: an initial dose of 1.0 to 2.0 mg IV with
subsequent doses based upon clinical response. Atypical
responses in blood pressure and heart rate have been reported
with other cholinomimetics when co-administered with quaternary
anticholinergics such as glycopyrrolate. It is not known
whether ARICEPT™ and/or its metabolties can be removed
by dialysis (hemodialysis, peritoneal dialysis, or hemofiltration).
Dose-related signs of toxicity in animals included reduced
spontaneous movement, prone position, staggering gait,
lacrimation, clonic convulsions, depressed respiration,
salivation, miosis, tremors, fasciculation and lower body
surface temperature.
CONTRAINDICATIONS
ARICEPT™ is contraindicated in patients with known
hypersensitivity to donepezil hydrochloride or to piperidine
derivatives.
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