Question: In adults with dementia, what length of time should be left after stopping donepezil before initiating another cholinesterase inhibitor?

Answer:

Information on the optimal washout period for donepezil, before initiating another cholinesterase inhibitor, was very limited. Two, poorly reported randomised controlled trials compared different methods of switching from donepezil to memantine and galantamine, respectively. There was no strong evidence from either trial to suggest that either the length of washout period or abrupt versus stepwise cessation of donepezil made a significant difference to the effectiveness or safety of treatment. One study reported that a shorter washout period (4 versus 7 days) was associated with fewer gastrointestinal adverse events during the final week of galantamine dose escalation, however, this finding was based on a small number of events and would require further investigation to confirm the apparent association.

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