Drug Action
Donepezil is a reversible inhibitor of acetylcholinesterase.
PDF page 338
Loading InternPractice…
Drug reference
Donepezil is a reversible inhibitor of acetylcholinesterase.
PDF page 338
Mild to moderate dementia in Alzheimer’s disease ▶BY MOUTH ▶Adult: Initially 5 mg once daily for one month, then increased if necessary up to 10 mg daily, doses to be given at bedtime
PDF page 338
Asthma. chronic obstructive pulmonary disease. sick sinus syndrome. supraventricular conduction abnormalities. susceptibility to peptic ulcers CAUTIONS, FURTHER INFORMATION ▶Elderly For acetylcholinesterase inhibitors, prescription potentially inappropriate (STOPP criteria) in patients with a known history of persistent bradycardia (heart rate less than 60 beats per minute), heart block, recurrent unexplained syncope, or concurrent treatment with drugs that reduce heart rate (risk of cardiac conduction failure, syncope and injury). See also Prescribing in the elderly p. 33.
PDF page 338
NICE decisions ▶Donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease (updated June 2018) NICE TA217 The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine, and rivastigmine as monotherapies are recommended as options for managing mild to moderate Alzheimer’s disease under all of the conditions specified below and in recommendation 1.5.5 of the NICE guideline on dementia. If prescribing an AChE inhibitor (donepezil, galantamine, or rivastigmine), treatment should normally be started with the drug with the lowest acquisition cost (taking into account required daily dose and the price per dose once shared care has started). However, an alternative AChE inhibitor could be prescribed if it is considered appropriate when taking into account adverse event profile, expectations about adherence, medical comorbidity, possibility of drug interactions and dosing profiles. Healthcare professionals should not rely solely on assessment scales to determine the severity of Alzheimer’s disease when the patient has learning or other disabilities, or other communication difficulties. www.nice.org.uk/guidance/ta217
PDF page 338
→Appendix 1: anticholinesterases, centrally acting
PDF page 338
▶Common or very common Aggression. agitation. appetite decreased. common cold. diarrhoea. dizziness. fatigue. gastrointestinal disorders. hallucination. headache. injury. muscle cramps. nausea. pain. skin reactions. sleep disorders. syncope. urinary incontinence. vomiting ▶Uncommon Bradycardia. gastrointestinal haemorrhage. hypersalivation. seizure ▶Rare or very rare Cardiac conduction disorders. extrapyramidal symptoms. hepatic disorders. neuroleptic malignant syndrome. rhabdomyolysis SIDE-EFFECTS, FURTHER INFORMATION Dose should be started low and increased if tolerated and necessary.
PDF page 338
Manufacturer advises caution (risk of increased exposure in mild to moderate impairment; no information available in severe impairment). Dose adjustments Manufacturer advises dose escalation should be performed according to individual tolerability in mild to moderate impairment.
PDF page 338
Donepezil orodispersible tablet should be placed on the tongue, allowed to disperse, and swallowed.
PDF page 338
There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension Oral solution ▶Donepezil hydrochloride (Non-proprietary) Donepezil hydrochloride 1 mg per 1 ml Donepezil 1mg/ml oral solution sugar free sugar-free | 150 ml P £53.73 DT = £50.99 Orodispersible tablet ▶Donepezil hydrochloride (Non-proprietary) Donepezil hydrochloride 5 mg Donepezil 5mg orodispersible tablets sugar free sugar-free | 28 tablet P £9.26–£50.87 DT = £9.26 Donepezil hydrochloride 10 mg Donepezil 10mg orodispersible tablets sugar free sugar-free | 28 tablet P £10.42–£71.31 DT = £10.42 ▶Aricept Evess (Eisai Ltd) Donepezil hydrochloride 5 mg Aricept Evess 5mg orodispersible tablets sugar-free | 28 tablet P £59.85 DT = £9.26 Donepezil hydrochloride 10 mg Aricept Evess 10mg orodispersible tablets sugar-free | 28 tablet P £83.89 DT = £10.42 Tablet ▶Donepezil hydrochloride (Non-proprietary) Donepezil hydrochloride 5 mg Donepezil 5mg tablets | 28 tablet P £59.85 DT = £0.98 Donepezil hydrochloride 10 mg Donepezil 10mg tablets | 28 tablet P £83.89 DT = £1.22 ▶Aricept (Eisai Ltd) Donepezil hydrochloride 5 mg Aricept 5mg tablets | 28 tablet P £59.85 DT = £0.98 Donepezil hydrochloride 10 mg Aricept 10mg tablets | 28 tablet P £83.89 DT = £1.22
PDF pages 338, 339
Patient or carers should be given advice on how to administer donepezil hydrochloride orodispersible tablets.
PDF page 338
Initially 5 mg once daily for one month, then
First-line fragment. Read the complete Indications and Dose section above.
PDF page 338