{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:51:11Z","timestamp":1761562271259,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2017,7,28]],"date-time":"2017-07-28T00:00:00Z","timestamp":1501200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Alzheimer\u2019s disease (AD) impacts millions of individuals worldwide. Since no cure is currently available, acetylcholinesterase inhibitors are symptomatic therapy. This study assessed community pharmacists\u2019 knowledge regarding donepezil adverse effects (AEs) and self-care recommendations for insomnia management for persons with AD treated with rivastigmine. This is a cross-sectional, standardized telephone survey of community pharmacists (n = 862) in three study areas: West Virginia, North Dakota\/South Dakota, and Southern Oregon\/Northern California. Pharmacists\u2019 degree, sex, and pharmacists\u2019 AD-related knowledge were assessed. In-stock availability of donepezil and rivastigmine formulations was assessed. Analyses were performed using Stata 10.1. Only 31.4% pharmacists were able to name \u22652 donepezil AEs. Only four donepezil AEs were named by at least 13% of pharmacists: nausea (36.1%), dizziness (25.1%), diarrhea (15.0%), and vomiting (13.9%). All other AEs were named by fewer than 7% of respondents. Only 62.9% of pharmacists (n = 542) provided appropriate recommendations: melatonin (40.3%), referral to physician (22.0%), or sleep hygiene (0.6%). Over 12% of pharmacists (n = 107) provided inappropriate recommendations (anticholinergic agent or valerian root) and 21.5% of pharmacists were unable to provide any recommendation. We identified significant gaps in community pharmacists\u2019 knowledge regarding donepezil AEs and non-prescription insomnia recommendation needing significant improvement to ensure high-quality AD-related care.<\/jats:p>","DOI":"10.3390\/pharmacy5030042","type":"journal-article","created":{"date-parts":[[2017,7,28]],"date-time":"2017-07-28T10:14:34Z","timestamp":1501236874000},"page":"42","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Community Pharmacists\u2019 Knowledge Regarding Donepezil Averse Effects and Self-Care Recommendations for Insomnia for Persons with AD"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4998-8921","authenticated-orcid":false,"given":"Marketa","family":"Marvanova","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, School of Pharmacy\/College of Health Professions, North Dakota State University, Department 2650, P.O. Box 6050, Fargo, ND 58108-6050, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Henkel","sequence":"additional","affiliation":[{"name":"Department of Geographical and Historical Studies, University of Eastern Finland, FI-80101 Joensuu, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2017,7,28]]},"reference":[{"key":"ref_1","unstructured":"Alzheimer\u2019s Association (2017, June 02). 2017 Alzheimer\u2019s Disease Facts and Figures. Available online: http:\/\/preview.alz.org\/ri\/documents\/facts2017_report(1).pdf."},{"key":"ref_2","first-page":"347","article-title":"Pathogenesis of Alzheimer's disease","volume":"2","author":"Swerdlow","year":"2007","journal-title":"Clin. Interv. Aging"},{"key":"ref_3","unstructured":"Alzheimer Disease International (2013). Policy Brief: The Global Impact of Dementia 2013\u20132050, Alzheimer Disease International. Available online: https:\/\/www.alz.co.uk\/research\/GlobalImpactDementia2013.pdf."},{"key":"ref_4","unstructured":"(2017, May 18). Aricept (Donepezil Hydrochloride) Tablets Package Insert. Available online: http:\/\/labeling.pfizer.com\/ShowLabeling.aspx?id=510."},{"key":"ref_5","unstructured":"(2017, May 18). Razadyne (Galantamine Hydrobromide) Tablets Package Insert. Available online: http:\/\/www.janssen.com\/us\/sites\/www_janssen_com_usa\/files\/products-documents\/razadyne_er_1.pdf."},{"key":"ref_6","unstructured":"(2017, May 18). Exelon (Rivastigmine Tartrate) Capsules Package Insert. Available online: http:\/\/pharma.us.novartis.com\/product\/pi\/pdf\/exelon.pdf."},{"key":"ref_7","unstructured":"(2017, May 18). Exelon (Rivastigmine Transdermal System) Patch Package Insert. Available online: http:\/\/www.pharma.us.novartis.com\/product\/pi\/pdf\/exelonpatch.pdf."},{"key":"ref_8","unstructured":"(2017, May 18). Namenda (Memantine HCl) Tablets for Oral Use, Package Insert. Available online: https:\/\/www.allergan.com\/assets\/pdf\/namenda_pi."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1212\/WNL.56.9.1154","article-title":"Practice Parameter: Management of Dementia (an Evidence-Based Review). Report of the Quality Standards Subcommittee of the American Academy of Neurology","volume":"56","author":"Doody","year":"2001","journal-title":"Neurology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/2046-4053-1-31","article-title":"Efficacy of cognitive enhancers for Alzheimer\u2019s disease: Protocol for a systemic review and network meta-analysis","volume":"1","author":"Tricco","year":"2012","journal-title":"Syst. Rev."},{"key":"ref_11","unstructured":"Morrison, C.M., Glover, D., Gilchrist, S.M., Casey, M.O., Lanza, A., Lane, R.I., and Patanian, M. (2017, June 15). A Program Guide for Public Health: Partnering with Pharmacists in the Prevention and Control of Chronic Diseases, Available online: http:\/\/www.cdc.gov\/dhdsp\/programs\/spha\/docs\/pharmacist_guide.pdf."},{"key":"ref_12","unstructured":"Giberson, S., Yoder, S., and Lee, M.P. (2017, June 08). Improving Patient and Health System Outcomes through Advanced Pharmacy Practice: A Report to the U.S. Surgeon General. Available online: http:\/\/www.accp.com\/docs\/positions\/misc\/improving_patient_and_health_system_outcomes.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1331\/JAPhA.2008.08144","article-title":"White paper on expanding the role of pharmacists in caring for individuals with Alzheimer\u2019s disease: APhA Foundation Coordinating Council to Improve Collaboration in Supporting Patients with Alzheimer\u2019s Disease","volume":"48","author":"Skelton","year":"2008","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref_14","unstructured":"(2017, May 10). United States Census Bureau, Available online: https:\/\/www.census.gov\/quickfacts\/table\/PST045216\/38."},{"key":"ref_15","unstructured":"Stafford, A. (2015). The pharmacist\u2019s role in supporting people living with dementia in the community. Aust. Pharm., 34, Available online: http:\/\/www.detectearly.org.au\/wp-content\/uploads\/2015\/02\/The-pharmacists-role-in-supporting-people-living-with-dementia.pdf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1007\/s11096-013-9904-7","article-title":"Cognitive memory screening and referral program in community pharmacies in the United States","volume":"36","author":"Rickles","year":"2014","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.5688\/aj7410S7","article-title":"Pharmacists\u2019 contributions to primary care in the United States collaborating to address unmet patient care needs: The emerging role for pharmacists to address the shortage of primary care providers","volume":"74","author":"Manolakis","year":"2010","journal-title":"Am. J. Pharm. Educ."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Marvanova, M., and Henkel, P. (2017). Community pharmacists\u2019 knowledge of Alzheimer\u2019s disease care in high- and low-income Chicago. J. Am. Pharm. Assoc.","DOI":"10.1016\/j.japh.2017.05.011"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1007\/s11096-016-0380-8","article-title":"Knowledge and pharmacological management of Alzheimer\u2019s disease by managing community pharmacists: A nationwide study","volume":"38","author":"Zerafa","year":"2016","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1002\/gps.3931","article-title":"Community pharmacists and people with dementia: A cross-sectional survey exploring experiences, attitudes, and knowledge of pain and its management","volume":"28","author":"Barry","year":"2013","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_21","first-page":"198","article-title":"Innovative Community Pharmacy Practice Models in North Carolina","volume":"78","author":"Hemberg","year":"2017","journal-title":"N. C. Med. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E149","DOI":"10.5888\/pcd13.160232","article-title":"Provision of Clinical Preventive Services by Community Pharmacists","volume":"13","author":"Kelling","year":"2016","journal-title":"Prev. Chronic Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1111\/jgs.14827","article-title":"Adherence and Tolerability of Alzheimer\u2019s Disease Medications: A Pragmatic Randomized Trial","volume":"65","author":"Campbell","year":"2017","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"431","DOI":"10.2165\/11318010-000000000-00000","article-title":"Predictive factors of discontinuation and switch of cholinesterase inhibitors in community-dwelling patients with Alzheimer's disease: A 2-year prospective, multicentre, cohort study","volume":"24","author":"Gardette","year":"2010","journal-title":"CNS Drugs"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.2165\/0002512-200825120-00005","article-title":"Adherence to medication in patients with dementia: Predictors and strategies for improvement","volume":"25","author":"Arlt","year":"2008","journal-title":"Drugs Aging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1017\/S1041610208007011","article-title":"Discontinuation of donepezil for the treatment of Alzheimer\u2019s disease in geriatric practice","volume":"20","author":"Umegaki","year":"2008","journal-title":"Int. Psychogeriatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1248\/yakushi.15-00109","article-title":"Effectiveness of Pharmacists\u2019 Comprehensive Assessment of Medication Profiles in Dementia Patients","volume":"135","author":"Nanaumi","year":"2015","journal-title":"Yakugaku Zasshi"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1248\/yakushi.132.387","article-title":"Pilot study of dementia medication compliance conducted among pharmacists providing home visits which evaluates the degree of drug compliance, as defined by numerous attributes, between patients at home and patients in a medical facility","volume":"132","author":"Nanaumi","year":"2012","journal-title":"Yakugaku Zasshi"},{"key":"ref_29","first-page":"605","article-title":"Pharmacist-based Donepezil Outpatient Consultation Service to improve medication persistence","volume":"6","author":"Watanabe","year":"2012","journal-title":"Patient Prefer Adherence"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1159\/000454948","article-title":"Comedication and Treatment Length in Users of Acetylcholinesterase Inhibitors","volume":"7","author":"Hjellvik","year":"2017","journal-title":"Demen Geriatr. Cogn. Dis. Extra"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"American Geriatrics Society 2015 Beers Criteria Update Expert Panel (2015). American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J. Am. Geriatr. Soc., 63, 2227\u20132246.","DOI":"10.1111\/jgs.13702"},{"key":"ref_32","first-page":"1471","article-title":"Disease-modifying drugs in Alzheimer\u2019s disease","volume":"7","author":"Ghezzi","year":"2013","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1503\/cmaj.081103","article-title":"Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia","volume":"179","author":"Hogan","year":"2008","journal-title":"CMAJ"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1592\/phco.2005.25.12.1729","article-title":"Decreased persistence to cholinesterase inhibitor therapy with concomitant use of drugs that can impair cognition","volume":"25","author":"Kogut","year":"2005","journal-title":"Pharmacotherapy"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/0165-0173(95)00016-X","article-title":"Acetylcholine: A neurotransmitter for learning and memory?","volume":"21","author":"Blokland","year":"1995","journal-title":"Brain Res. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2340","DOI":"10.1016\/j.clinthera.2016.09.010","article-title":"Review of Safety and Efficacy of Sleep Medicines in Older Adults","volume":"38","author":"Schroeck","year":"2016","journal-title":"Clin. Ther."},{"key":"ref_37","first-page":"265","article-title":"In vitro activity of commercial valerian root extracts against human cytochrome P450 3A4","volume":"7","author":"Lefebvre","year":"2004","journal-title":"J. Pharm. Pharm. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s11910-017-0745-y","article-title":"Circadian Disruption Associated with Alzheimer's Disease","volume":"17","author":"Saeed","year":"2017","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1002\/gps.2609","article-title":"Treatment of sleep disturbance in Alzheimer's dementia","volume":"26","author":"Salami","year":"2011","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.sleep.2006.11.010","article-title":"Disturbance and strategies for reactivation of the circadian rhythm system in aging and Alzheimer\u2019s disease","volume":"8","author":"Wu","year":"2007","journal-title":"Sleep Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1272\/jnms.70.334","article-title":"Double blind study of melatonin effects on the sleep-wake rhythm, cognitive and non-cognitive functions in Alzheimer type dementia","volume":"70","author":"Asayama","year":"2003","journal-title":"J. Nippon. Med. Sch."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"McCleery, J., Cohen, D.A., and Sharpley, A.L. (2016). Pharmacotherapies for sleep disturbances in dementia. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD009178.pub3"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1331\/JAPhA.2015.14288","article-title":"Potentially inappropriate anticholinergic medication use in older adults with dementia","volume":"55","author":"Kachru","year":"2015","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.amjopharm.2011.10.001","article-title":"Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia","volume":"9","author":"Bhattacharya","year":"2011","journal-title":"Am. J. Geriatr. Pharmacother."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Abraham, O., Schleiden, L., and Albert, S.M. (2017). Over-the-counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep. Int. J. Clin. Pharm.","DOI":"10.1007\/s11096-017-0467-x"}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/5\/3\/42\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:44:23Z","timestamp":1760208263000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/5\/3\/42"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,28]]},"references-count":45,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2017,9]]}},"alternative-id":["pharmacy5030042"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy5030042","relation":{},"ISSN":["2226-4787"],"issn-type":[{"type":"electronic","value":"2226-4787"}],"subject":[],"published":{"date-parts":[[2017,7,28]]}}}