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вЂњThere is very little evidence that itвЂ™s superior,вЂќ Lah, an Alzheimer's clinician and associate professor said. He said he was concerned when the FDA approved the 23-milligram version.

itвЂ™s simply not true in this particular instance,вЂќ Lah said. вЂњBeing Americans, the notion is that bigger is better, more is better. James Lah, director of the cognitive neurology program at Emory University's Department of Neurology, regularly prescribes Aricept to patients, but doesn't prescribe the 23-milligram dose. Food and Drug Administration for the treatment of moderate-to-severe AlzheimerвЂ™s disease. In response, Pfizer, which co-promotes Aricept with another company, Eisai, wrote in an emailed statement: 'We are reviewing the petition and will respond accordingly however, it is important to note that the Aricept (donepezil HCl) 23 mg tablet has been approved by the U.S. And AlzheimerвЂ™s patients are particularly sensitive to vomiting because it can lead to other problems such as pneumonia, massive gastrointestinal bleeding, esophageal rupture and even death, the group said. Patients often stop taking the higher dose because of its strong side effects such as vomiting. The group also said the higher dose does not appear to give any benefits to the patients. The group says that the drug in higher dose compared with the 10-milligrams could pose increased adverse effects such as slowed pulse rate, nausea, vomiting, diarrhea, urinary incontinence, fatigue, dizziness and agitation.

The Public CitizenвЂ™s Health Research Group called the 23-milligram dose of Aricept вЂњsignificantly more toxicвЂќ than the 10-milligram dose and said it вЂњshould be immediately withdrawn from the market.вЂќ Aricept which is taken daily, could slow the mental decline, but it does not cure or prevent Alzheimer's. It is prescribed to improve mental function, such as memory, attention and reasoning by increasing a brain chemical. The drug, donepezil, sold under the brand Aricept, is administered in several doses вЂ“ the highest being 23 milligrams вЂ“ for patients with moderate to severe AlzheimerвЂ™s disease. A specific dose of AlzheimerвЂ™s drug should be pulled from the market because it poses a risk to patients, according to a consumer group.

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