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.
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.
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
NO BOXED WARNINGS
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.
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