Class: Cholinesterase Inhibitor
Dosage Forms. Tablet: 5 mg, 10 mg, 23 mg; Disintegrating Tablet: 5 mg, 10 mg
Common FDA Label Indication, Dosing, and Titration.
1. Alzheimer disease, dementia (mild-moderate): 5 mg po daily hs, may titrate to max of 10 mg/d
2. Alzheimer disease, dementia (moderate-severe): 5 mg po qhs, may titrate to 10 mg/d at 4-6 wk to max of 23 mg/d (immediate-release tablet) or 10 mg/d (disintegrating tablet)
1. Multi-infarct dementia: 5-10 mg po daily hs
MOA. Donepezil enhances the action of acetylcholine by reversibly inhibiting acetylcholinesterase (AChE), the enzyme responsible for its hydrolysis. It has a high degree of selectivity for AChE in the CNS, which might explain the relative lack of peripheral side effects.
Drug Characteristics: Donepezil
Medication Safety Issues: Donepezil
Drug Interactions: Donepezil
Adverse Reactions: Donepezil
Efficacy Monitoring Parameters. Improvement in symptoms of Alzheimer-type dementia.
Toxicity Monitoring Parameters. Symptoms of active or occult GI bleeding, particularly if patient has history of ulcer disease or is receiving concomitant NSAIDs.
Key Patient Counseling Points. Take at bedtime, with or without food. Allow disintegrating tablet to dissolve on tongue and follow with a glass of water. Adverse effects may be more frequent at dose escalation and tend to resolve with continued use. Report signs/symptoms of GI bleeding.
Clinical Pearls. Safety and effectiveness not established in children. No evidence suggests that donepezil alters the course of Alzheimer disease.