Donepezil
ARICEPT
Pronunciation: doe-NEP-e-zil
“Donnie Pez is Air except (for Alzheimer’s brain)”
Light blue → cholinergic / muscarinic
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.
Pearls
- Not recommended for mild cognitive impairment.
- 23 mg/day: small cognitive gain over 10 mg, more GI effects.
- Nausea, diarrhea and cramps usually fade with continued use.
- Vivid dreams or insomnia: move the dose to morning.
Donepezil prescription history
Animated chart of estimated U.S. prescriptions per year, Dementia meds (1993–2026). Donepezil enters in 1997 (estimated).
FDA-approved for
- Alzheimer dementia (1996)
Principal riskBradycardia and syncope
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityBradycardia, syncope or GI effects for symptomatic drugs; anti-amyloid agents add edema/hemorrhage risk.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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.
Available strengths
- tab 5, 10, 23 mg
- ODT 5, 10 mg
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
Cost
Generic entry2009
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Self-check
- Does donepezil alter Alzheimer progression?
No; symptomatic benefit. - Which severity is included on donepezil’s label unlike galantamine?
Severe Alzheimer dementia.