Donepezil, Rivastigmine & Galantamine:
Use in Renal and Hepatic Impairment
- Single doses of donepezil can be safely administered to patients with moderately to severely impaired renal function (creatinine clearance < 30 ml/ min)
- Multiple doses can be safely administered to patients with moderately impaired renal function (creatinine clearance 17–33 ml/min)
- Multiple-dose studies of donepezil in patients with hepatic impairment (not to exceed Grade B as defined by the Child-Pugh Classification) indicate that donepezil 5 mg/day is a safe and well-tolerated treatment.
Source: Br J Clin Pharmacol. Nov 2004; 58(Suppl 1): 1–8.
- In patients with moderate to severe renal impairment (glomerular filtration rate <50 mL/min), clearance of oral rivastigmine was reduced. Accordingly, such patients may be able to only tolerate lower doses.
- In patients with mild or moderate hepatic impairment (Child-Pugh score 5 to 9), clearance of oral rivastigmine was reduced. Accordingly, such patients may be able to only tolerate lower doses.
- No data are available on the use of rivastigmine in patients with severe hepatic impairment.
Source: Rivastigmine Package Insert
- Use with caution in patients with mild-to-moderate liver impairment; not recommended in severe impairment.
- Use with caution in patients with moderate renal impairment; not recommended in severe impairment (CrCl <9 mL/minute).
Please do post your questions or comments below.
Dr. Harvinder Singh, M.D. (Admin)
Enroll in our online course to have access to all important clinically relevant psychiatry topics in one place.