Adult & elderly Initially 5 mg once daily in evening before bedtime. Maintain dose for at least 1 mth. May be increased to 10 mg once daily in patients who tolerated 5 mg once daily dosing following 4-6 wk clinical assessment. Vascular dementia & DLB Max recommended daily dose: 10 mg. DLB May be decreased to 5 mg depending on patient's symptoms.
Consider discontinuation when evidence of therapeutic effect is no longer present. Patients w/ sick sinus syndrome or other supraventricular cardiac conduction conditions eg, SA or AV block; history of asthma or obstructive pulmonary disease; at increased risk for developing ulcers eg, w/ history of ulcer disease or those receiving concurrent NSAIDs. Vagotonic effects on heart rate (eg, bradycardia); syncope & seizures; possibility of heart block or long sinusal pauses; bladder outflow obstruction; potential to cause generalized convulsions. May likely to exaggerate succinylcholine-type muscle relaxation during anaesth. May exacerbate or induce extrapyramidal symptoms. Avoid concomitant administration w/ other acetylcholinesterase inhibitors, cholinergic agonists or antagonists. May affect ability to drive & use machines. Severe hepatic impairment. Not to be used during pregnancy. Lactation. Not recommended in childn.
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