Donepezil - Chris Aiken, MD

Donepezil (Aricept)

Acetylcholinesterase inhibitor

Alzheimer’s Dementia¹ (mild, moderate, severe).
Vascular dementia²

Ineffective: General cognition

Features

Non-controlled, Generic, Bipolar-Safe, Elderly-Preferred, Weight-Free, Sexual-free, Non-sedating, Medication, Elderly-Safe, Tolerable

Handout

Dosing

Start 5 mg daily, raise every 2-4 weeks, target 5-23 mg daily.

INTERACTIONS: anticholinergic medications (eg, antipsychotics) may block effects. Lower 50% to adjust for higher levels with strong CYP2D6 inhibitors (asenapine, bupropion, cannabidiol, duloxetine, and non-pram SSRIs: fluoxetine, paroxetine, sertraline ≥ 150 mg/day).

Management

First line for dementia, where it has a mild benefit in slowing the progression and approval at all levels. Can be combined with memantine. Another cholinesterase inhibitor, rivastigmine, is second line (it comes as a patch, which cuts down on GI side effects).

Does not improve cognition in other conditions.

TOLERABILITY: Bradycardia, nausea, diarrhea, anorexia, abdominal pain, muscle cramps, vivid dreams.

RISKS: Hypotension, syncope, rare risks of stomach bleeding, bladder obstruction, heart block. It may worsen epilepsy and asthma.

EMR Text

Dementia

Donepezil use based on FDA approval in dementia where it slowed progression of the illness and improved behavioral symptoms (Lockhart IA et al, Dement Geriatr Cogn Dis Extra 2011;1(1):212–227).

Donepezil side effects reviewed with patient.

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