Donepezil
ARICEPT
What it isCentrally acting acetylcholinesterase inhibitor; Alzheimer dementia at all stages.
Why this oneUnlike galantamine, its label extends to severe Alzheimer dementia, so it can be continued as disease advances.
What limits itCholinergic effects — bradycardia, syncope, GI upset and vivid dreams. The benefit is symptomatic; it does not alter progression.
FDA-approved for
- Alzheimer dementia (1996)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Alzheimer's disease, mild–moderate | Adults | 5 mg QHS | 10 mg QD | 10 mg QD |
| Alzheimer's disease, moderate–severe | Adults | 5 mg QHS | 10–23 mg QD | 23 mg QD |
Titration Increase to 10 mg only after 4–6 wk at 5 mg; increase to 23 mg only after ≥3 mo at 10 mg.
Renal Undefined
Hepatic Undefined
Instructions
- Take in the evening, just before retiring; with or without food.
- Do not split, crush, or chew the 23 mg tablet.
Contraindications
- Known hypersensitivity to piperidine derivatives
Cautions
- Exaggerates succinylcholine-type muscle relaxation during anesthesia
- Vagotonic effects — bradycardia/heart block, syncope
- Nausea/vomiting
- GI bleeding, esp. ulcer-prone patients
- Weight loss (23 mg dose)
- Bladder outflow obstruction
- Seizures
- Caution in asthma/COPD
Adverse reactions
- Nausea
- Diarrhea
- Insomnia
- Vomiting
- Muscle cramps
- Fatigue
- Anorexia
Pregnancy No adequate human data; animal data show increased stillbirths/decreased offspring survival at clinically relevant doses
Lactation Undefined
NO BOXED WARNINGS
Principal riskBradycardia and syncope
Cost, est. cash$10–$500/month
Generic entry2009
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityBradycardia, syncope or GI effects for symptomatic drugs; anti-amyloid agents add edema/hemorrhage risk.
Mechanism of action: Donepezil ballicule
Open Donepezil in the interactive console ↗
Memory aids: mascots and interaction avatars
Light blue → cholinergic / muscarinic
