Class
- Cholinesterase inhibitor
Donepezil
Commonly Prescribed for
(FDA approved in bold)
- Alzheimer dementia (AD) (mild, moderate or severe)
- Vascular dementia
- Mild cognitive impairment
- Dementia with Lewy bodies (DLB)
- HIV dementia
- Autism
- Attention deficit hyperactivity disorder (ADHD)
Donepezil
How the Drug Works
- Increases the concentration of acetylcholine through reversible, non-competitive inhibition of acetylcholinesterase, which increases availability of acetylcholine. A deficiency of cholinergic function is felt to be important in producing the signs and symptoms of AD. May interfere with amyloid deposition
- Although symptoms of AD can improve, donepezil does not prevent disease progression
Donepezil
How Long Until It Works
- Typically 2–6 weeks at a given dose, but effect is best observed over a period of months
Donepezil
If It Works
- Continue to use but symptoms of dementia usually continue to worsen
Donepezil
If It Doesn’t Work
- Non-pharmacologic measures are the basis of dementia treatment. Maintain regular schedules and routines. Avoid prolonged travel, unnecessary medical procedures or emergency room visits, crowds, and large social gatherings
- Limit drugs with sedative properties such as opioids, hypnotics, Antiepileptic drugs and tricyclic antidepressants
- Consider adjusting dose
- Treat other disorders which can worsen symptoms such as hyperglycemia or urinary difficulties
Donepezil
Best Augmenting Combos for Partial Response or Treatment-Resistance
- Addition of the NMDA receptor antagonist memantine may be beneficial. In 1 study donepezil plus memantine reduced the rate of progression compared to those taking donepezil alone
- Treat depression or apathy, if present, with SSRIs. Avoid tricyclic antidepressants in demented patients due to risk of confusion
- For significant confusion and agitation avoid neuroleptics (especially in Lewy Body dementia) to avoid the risk of neuroleptic malignant syndrome. Atypical antipsychotics (risperidone, quetiapine, olanzapine, clozapine) can be used instead
Donepezil
Tests
- None required
Adverse Effects (AEs)
Donepezil
How Drug Causes AEs
- Acetylcholinesterase inhibition in the CNS and PNS
Donepezil
Notable AEs
- GI AEs (nausea, diarrhea, anorexia and weight loss) are most common
- Fatigue, depression, dizziness, muscle cramps and sleep disturbances
Donepezil
Life-Threatening or Dangerous AEs
- Rarely bradycardia or heart block causing syncope. Generalized convulsions. Increases gastric acid secretions which can predispose to GI bleeding
Donepezil
Weight Gain
- Unusual
- Weight loss is more common
Donepezil
Sedation
- Unusual
Donepezil