(doe nep' ah zill)
Pregnancy Category C
Alzheimer's disease drug
Centrally acting reversible cholinesterase inhibitor leading to elevated acetylcholine levels in the cortex, which slows the neuronal degradation that occurs in Alzheimer's disease.
· Treatment of mild to moderate dementia of the Alzheimer's type
Contraindications and cautions
· Contraindicated with allergy to donepezil.
· Use cautiously with sick sinus syndrome, GI bleeding, seizures, asthma, pregnancy, lactation.
Tablets—5, 10 mg
5 mg PO daily hs. May be increased to 10 mg daily after 4–6 wk.
Safety and efficacy not established.
Metabolism: Hepatic; T1/2: 70 hr
Distribution: Crosses placenta; may enter breast milk
· CNS: Insomnia, fatigue, dizziness, confusion, ataxia, somnolence, tremor, agitation, depression, anxiety, abnormal thinking
· Dermatologic: Rash, flushing, purpura
· GI: Nausea, vomiting, diarrhea, dyspepsia, anorexia, abdominal pain, flatulence, constipation, hepatotoxicity
· Other: Muscle cramps
· Increased effects and risk of toxicity with theophylline, cholinesterase inhibitors
· Decreased effects of anticholinergics
· Increased risk of GI bleeding with NSAIDs
· Decreased efficacy with anticholinergics
Name confusion has occurred between Aricept (donepezil) and Aciphex (rabeprazole); use caution.
· History: Allergy to donepezil, pregnancy, lactation, sick sinus syndrome, GI bleeding, seizures, asthma
· Physical: Orientation, affect, reflexes; BP, P; abdominal examination; renal and liver function tests
· Administer hs each day.
· Provide small, frequent meals if GI upset is severe.
· Notify surgeons that patient is on donepezil; exaggerated muscle relaxation may occur if succinylcholine-type drugs are used.
· Take this drug exactly as prescribed, at bedtime.
· This drug does not cure the disease but is thought to slow down the degeneration associated with the disease.
· Arrange for regular blood tests and follow-up visits while adjusting to this drug.
· You may experience these side effects: Nausea, vomiting (eat frequent small meals); insomnia, fatigue, confusion (use caution if driving or performing tasks that require alertness).
· Report severe nausea, vomiting, changes in stool or urine color, diarrhea, changes in neurologic functioning, yellowing of eyes or skin.
Adverse effects in Italic are most common; those in Bold are life-threatening.