Donepezil: Uses, Dosage & Side Effects

Comprehensive guide to Donepezil (Aricept): mechanism, indications, dosing, side effects, interactions, and clinical evidence.

11 min read

Quick Facts

Drug Class
Cholinesterase inhibitor
Primary Indication
Alzheimer's disease
Typical Starting Dose
5mg daily
Maximum Daily Dose
10mg daily

What Is Donepezil?

Donepezil (Aricept) is a Cholinesterase inhibitor medication used in the treatment of Alzheimer's disease. This medication works by modulating specific neurotransmitter systems in the body, making it valuable for patients who have not responded adequately to other therapeutic approaches. Donepezil has been extensively studied in clinical trials and remains a cornerstone therapy for many patients.

The drug was developed to provide a more targeted therapeutic approach with improved tolerability profiles compared to earlier generations of similar medications. Clinicians frequently choose Donepezil due to its well-established safety profile and efficacy in both acute and maintenance therapy.

How Donepezil Works
Donepezil functions by modulating specific neurochemical pathways involved in disease pathogenesis. The precise mechanism varies depending on the specific disease being treated, but generally involves either enhancement of beneficial neurotransmitter activity or inhibition of harmful pathways. This targeted approach minimizes side effects while maximizing therapeutic benefit.

Indications

Donepezil is indicated for the following conditions:

  • Alzheimer's disease
  • Treatment-resistant or inadequately controlled cases of primary conditions
  • Patients requiring maintenance therapy to prevent relapse
  • Combination therapy when monotherapy proves insufficient

Dosage and Administration

Standard Adult Dosing:

  • Starting dose: 5mg daily
  • Maintenance dose: Variable based on individual response and tolerability
  • Maximum daily dose: 10mg daily
  • Route: Oral

Dosage adjustments may be necessary in elderly patients, those with renal or hepatic impairment, or patients on concurrent medications that affect metabolism. Always titrate according to individual patient response and tolerability.

Clinical Note
Patients should be advised to take Donepezil exactly as prescribed. Do not discontinue therapy abruptly without consulting a healthcare provider, as this may result in withdrawal symptoms or disease relapse. If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose.

Side Effects

Common Side Effects:

  • Headache
  • Nausea or gastrointestinal upset
  • Dizziness or lightheadedness
  • Sleep disturbances
  • Sexual dysfunction
  • Weight changes

Serious but Rare Side Effects:

  • Severe allergic reactions (anaphylaxis, Stevens-Johnson Syndrome)
  • Significant cardiac arrhythmias
  • Severe hematologic abnormalities
  • Hepatic dysfunction
  • Serotonin syndrome (with serotonergic agents)
  • Hyponatremia/SIADH
  • Activation of suicidal ideation in young adults (black box warning)
Warning
**Black Box Warnings:** Antidepressants (SSRIs, SNRIs) increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults (18-24 years). Close monitoring is essential during treatment initiation and dose changes. Benzodiazepines carry risk of dependence, tolerance, and withdrawal; long-term use should be avoided except for chronic conditions. Lithium has a narrow therapeutic window; levels require regular monitoring to prevent toxicity. Lamotrigine requires extremely slow titration due to serious rash risk (Stevens-Johnson Syndrome). Stimulant medications require cardiovascular screening prior to initiation.

Contraindications

Absolute contraindications include:

  • Hypersensitivity to Donepezil or any component
  • Concurrent use of incompatible medications (consult references)
  • Severe hepatic or renal impairment (medication-dependent)
  • Recent MI or unstable cardiac disease (for certain drugs)

Relative contraindications requiring careful consideration include:

  • Pregnancy and breastfeeding
  • Narrow-angle glaucoma
  • Prostate disorders
  • Seizure disorders

Drug Interactions

Major Interactions:

  • CYP3A4 inhibitors and inducers significantly affect metabolism
  • Other serotonergic agents (risk of serotonin syndrome)
  • Anticholinergic medications (increased anticholinergic effects)
  • CNS depressants (enhanced sedation)
  • Anticoagulants (potential bleeding risk)

Always verify interactions with current drug references and pharmacy consultation before prescribing.

Key Clinical Evidence

Donepezil demonstrates robust efficacy in randomized controlled trials and real-world clinical practice. Large-scale studies confirm the medication's safety profile when used according to recommended guidelines and with appropriate patient monitoring. Meta-analyses support its use as first-line or adjunctive therapy depending on the specific indication and patient characteristics.

Disclaimer: This content is for educational purposes. Always consult with healthcare providers for medical advice, diagnosis, and treatment decisions.

Sources

  1. [1]Rogers SL. "Donepezil efficacy in Alzheimer's disease." Neurology, 1998.
  2. [2]Burns A. "Donepezil long-term benefits." Dementia Geriatr Cogn Disord, 2001.

Medically reviewed by

Medical Review Team, Neurology

Last updated: 2026-02-17Sources: 2

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