Donepezil
Other CNS Drugs · Anticholinesterase
Indications
Mild to moderately severe Alzheimer's dementia.
Dosage
Adults: Initially 5 mg once daily at bedtime. Increase if necessary to max 10 mg at bedtime after 1 mth. Assess response 2-4 mth after reaching maintenance dose and only continue if positive evidence of benefit. Children: Not recommended.
Adverse Effects
GI upset, fatigue, pain, common cold, muscle cramps, headache, insomnia, dizziness, syncope, coryza, anorexia, rash, pruritus, urinary incontinence, psychiatric disturbances. Rarely, bradycardia, SA or AV block, seizures, raised creatine kinase, extra-pyramidal symptoms, GI haemorrhage, GI or duodenal ulcers. Liver dysfunction (consider withdrawal). Neuroleptic malignant syndrome.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Precautions: Diagnosis and treatment must be under supervision of a clinician experienced in Alzheimer's dementia. Hepatic impairment, supraventricular conduction disturbances, history or risk of GI ulceration, asthma, COPD, bladder outflow obstruction, seizures, extra-pyramidal symptoms. Risk of neuroleptic malignant syndrome.
Interactions
Neuromuscular blockers, cholinergics and anticholinergic agents, anaesthetics, beta-blockers, P450 enzyme inducers or inhibitors, antipsychotics, inducers and inhibitors of CYP3A4 or CYP2D6.
Advice to Patient
Take with or without meals. Take medication immediately before going to bed. Contact prescriber if there is dizziness, stomach discomfort, increased saliva/tears/urination/sweating, flushing of skin, chest pain or palpitations, increased fatigue, lack of sleep, acute headache, unrelieved diarrhoea, depression, increased muscle, body or joint pain, change in vision, blurred vision, difficulty in breathing, black or dark coloured stool. Do not take NSAIDs during therapy. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Change position slowly from sitting or lying to standing.
Pharmacokinetics
Absorption: Well absorbed. Metabolism: Extensive hepatic. Half-life elimination: 70 hours; time to steady-sate 15 days. Time to peak, plasma: Tablet, 10 mg: 3 hours. Tablet, 23 mg: Approx. 8 hours; Note: Peak plasma concentrations almost twofold higher for the 23 mg tablet compared to the 10 mg tablet. Excretion: Urine (57%; 17% as unchanged drug); feces (15%).
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
Always consult a pharmacist or doctor.