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Aricept
donepezil
Adult Dosing .
Dosage forms: TAB: 5 mg, 10 mg, 23 mg
Alzheimer dz, mild-moderate dementia
- [5-10 mg PO qhs]
- Start: 5 mg PO qhs x4-6wk, then may incr. to 10 mg PO qhs; Max: 10 mg/day
Alzheimer dz, moderate-severe dementia
- [10-23 mg PO qhs]
- Start: 5 mg PO qhs x4-6wk, then incr. to 10 mg PO qhs x3mo, then may incr. to 23 mg PO qhs; Max: 23 mg/day; Info: do not cut/crush/chew 23 mg tab
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to piperidine derivatives
- long QT syndrome, congenital
- caution: electrolyte abnormalities
- caution: QT prolongation
- caution: QT prolongation family hx
- caution: torsades de pointes hx
- caution: ventricular arrhythmia
- caution: cardiac conduction defect
- caution: bradycardia
- caution: MI, recent
- caution: CHF
- caution: GI ulcer hx
- caution: GI ulcer risk
- caution: bladder outflow obstruction
- caution: seizure disorder
- caution: asthma
- caution: COPD
- caution: wt <55 kg (>10 mg/day dose)
Drug Interactions .
Overview
donepezil
cholinesterase inhibitor
- CYP2D6 substrate
- CYP3A4 substrate
- bradycardia
- cholinergic effects
- delays atrioventricular conduction
- GI mucosal injury/bleeding risk
- lowers seizure threshold
- prolongs QT interval (known)
Contraindicated
- cisapride
- domperidone
- dronedarone
- levoketoconazole
- pimozide
- quinidine (CYP2D6 inhibitor)
- thioridazine
Avoid/Use Alternative
- adagrasib
- aldesleukin
- amifampridine
- amiodarone
- anagrelide
- apomorphine
- arsenic trioxide
- artemether/lumefantrine
- asenapine
- azithromycin
- bedaquiline
- brigatinib
- cabozantinib
- ceritinib
- citalopram
- clarithromycin
- clonidine
- crizotinib
- degarelix
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- disopyramide
- dofetilide
- donepezil
- droperidol
- efavirenz
- encorafenib
- entrectinib
- ephedra
- eribulin
- erythromycin
- etrasimod
- fexinidazole
- fingolimod
- flecainide
- fluoxetine
- foscarnet
- galantamine
- gepotidacin
- givinostat
- glasdegib
- goserelin
- grapefruit
- histrelin
- hydroxychloroquine
- ibutilide
- iloperidone
- inotuzumab ozogamicin
- iohexol
- isoflurane
- ivabradine
- ivosidenib
- landiolol
- lefamulin
- leuprolide
- levofloxacin
- lofexidine
- lonafarnib
- loperamide
- lopinavir/ritonavir
- macimorelin
- methacholine inhaled
- mifepristone
- mobocertinib
- moxifloxacin
- nilotinib
- osimertinib
- oxaliplatin
- ozanimod
- pacritinib
- paliperidone
- panobinostat
- pazopanib
- pentamidine
- phenobarbital
- pimavanserin
- pitolisant
- ponesimod
- procainamide
- propafenone
- pyridostigmine
- quetiapine
- quinidine (antiarrhythmic)
- quinine
- quizartinib
- revumenib
- ribociclib
- rilpivirine
- rivastigmine
- rucaparib
- sertraline
- sevoflurane
- siponimod
- solifenacin
- sorafenib
- sotalol
- succinylcholine
- tetrabenazine
- toremifene
- tramadol
- trazodone
- triptorelin
- vandetanib
- vemurafenib
- ziprasidone
Monitor/Modify Tx
- acebutolol
- adenosine
- afatinib
- albuterol
- albuterol inhaled
- alectinib
- alendronate
- alfentanil
- alfuzosin
- amisulpride
- amitriptyline
- apalutamide
- apraclonidine ophthalmic
- arformoterol inhaled
- articaine
- asciminib
- aspirin
- atazanavir
- atenolol
- axitinib
- berotralstat
- betamethasone
- betaxolol
- betaxolol ophthalmic
- bevacizumab
- bisoprolol
- brentuximab vedotin
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- cabazitaxel
- carbamazepine
- carteolol ophthalmic
- carvedilol
- celecoxib
- chloroprocaine
- chloroquine
- chlorpromazine
- cinacalcet
- ciprofloxacin
- clofazimine
- clomipramine
- clozapine
- corticotropin
- cortisone
- cysteamine
- dasatinib
- deferasirox
- deflazacort
- desflurane
- deuruxolitinib
- deutetrabenazine
- dexamethasone
- diclofenac
- diclofenac topical
- diflunisal
- digoxin
- diltiazem
- dimethyl fumarate
- diroximel fumarate
- dulaglutide
- eliglustat
- ensartinib
- epirubicin
- erlotinib
- escitalopram
- esmolol
- etelcalcetide
- ethanol
- etodolac
- fenoprofen
- fentanyl
- fluconazole
- fludrocortisone
- fluorouracil
- flurbiprofen
- formoterol inhaled
- fosphenytoin
- fostemsavir
- fruquintinib
- gefitinib
- gemtuzumab ozogamicin
- gepirone
- gilteritinib
- granisetron
- guanfacine
- haloperidol
- hydrocodone
- hydrocortisone
- hydroxyzine
- ibandronate
- ibuprofen
- ibuprofen lysine
- imatinib
- indomethacin
- iopamidol
- ketoprofen
- ketorolac
- labetalol
- lacosamide
- lamotrigine
- lanreotide
- lanthanum
- lapatinib
- lasmiditan
- lenvatinib
- levalbuterol inhaled
- levobunolol ophthalmic
- lidocaine
- lorlatinib
- lumateperone
- lurasidone
- magnesium salicylate
- mavorixafor
- meclofenamate
- mefenamic acid
- mefloquine
- meloxicam
- meperidine
- mepivacaine
- methadone
- methotrexate
- methylprednisolone
- metoprolol
- metronidazole
- midodrine
- midostaurin
- mirtazapine
- monomethyl fumarate
- mycophenolate mofetil
- mycophenolic acid
- nabumetone
- nadolol
- naproxen
- nebivolol
- neostigmine
- nintedanib
- octreotide
- ofloxacin
- oliceridine
- olodaterol inhaled
- ondansetron
- osilodrostat
- oxaprozin
- palonosetron
- pasireotide
- phenytoin
- pindolol
- piroxicam
- ponatinib
- porfimer
- posaconazole
- pralsetinib
- praziquantel
- prednisolone
- prednisone
- primaquine
- promethazine
- propranolol
- ramucirumab
- ranolazine
- regadenoson
- regorafenib
- relugolix
- remifentanil
- remimazolam
- risedronate
- ritonavir
- romidepsin
- ropivacaine
- sacituzumab govitecan
- salmeterol inhaled
- salsalate
- selpercatinib
- sufentanil
- sugammadex
- sulindac
- sunitinib
- tacrolimus
- tazemetostat
- telavancin
- temsirolimus
- terbutaline
- thalidomide
- ticagrelor
- timolol
- timolol ophthalmic
- tivozanib
- tocilizumab
- tolmetin
- tolterodine
- trametinib
- triamcinolone
- triclabendazole
- trifluridine
- upadacitinib
- vadadustat
- valbenazine
- vamorolone
- vardenafil
- venlafaxine
- verapamil
- vilanterol inhaled
- voclosporin
- voriconazole
- willow bark
- ziv-aflibercept
Caution Advised
- acetazolamide
- aclidinium inhaled
- amantadine
- amoxapine
- atracurium
- atropine
- belladonna alkaloids
- benztropine
- bethanechol
- brivaracetam
- brompheniramine
- busulfan
- butalbital
- cannabidiol
- carbinoxamine
- cenobamate
- cevimeline
- chlophedianol
- chlorambucil
- chlorpheniramine
- cisatracurium
- clemastine
- clidinium
- clobazam
- clonazepam
- clorazepate
- cyclobenzaprine
- cyproheptadine
- dacomitinib
- darifenacin
- dexbrompheniramine
- dexchlorpheniramine
- diazepam
- dicyclomine
- dimenhydrinate
- diphenhydramine
- dipyridamole
- doxepin
- doxepin topical
- doxylamine
- enzalutamide
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fenfluramine
- fesoterodine
- flavoxate
- fluphenazine
- gabapentin
- ganaxolone
- glycopyrrolate
- glycopyrrolate inhaled
- glycopyrronium topical
- homatropine
- hyoscyamine
- imipramine
- ipratropium inhaled
- levetiracetam
- lorazepam
- loxapine
- lumacaftor/ivacaftor
- magnesium citrate
- meclizine
- methocarbamol
- methscopolamine
- methsuximide
- midazolam
- mitotane
- molindone
- nortriptyline
- olanzapine
- orphenadrine
- oxcarbazepine
- oxybutynin
- paroxetine
- pentobarbital
- perampanel
- perphenazine
- pheniramine
- pilocarpine
- polyethylene glycol
- polyethylene glycol/electrolytes
- pregabalin
- primidone
- prochlorperazine
- protriptyline
- pyrilamine
- ramelteon
- revefenacin inhaled
- rifabutin
- rifampin
- rocuronium
- rufinamide
- scopolamine
- sodium picosulfate
- sofpironium topical
- St. John's wort
- stiripentol
- sulfate bowel prep
- terbinafine
- thiothixene
- tiagabine
- tiotropium inhaled
- topiramate
- treosulfan
- trifluoperazine
- trihexyphenidyl
- trimipramine
- triprolidine
- trospium
- umeclidinium inhaled
- valproic acid
- vecuronium
- vigabatrin
- zonisamide
Adverse Reactions .
Serious Reactions
- AV block
- bradycardia
- QT prolongation
- torsades de pointes
- syncope
- seizures
- neuroleptic malignant syndrome
- rhabdomyolysis
- GI bleeding
- hemolytic anemia
- urinary obstruction
Common Reactions
- nausea
- diarrhea
- headache
- insomnia
- pain
- dizziness
- muscle cramps
- vomiting
- fatigue
- anorexia
- ecchymosis
- weight loss
- depression
- abnormal dreams
- syncope
- arthritis
- somnolence
- urinary frequency
Safety/Monitoring .
Monitoring Parameters
weight; s/sx GI bleeding, esp. if incr. GI ulcer risk
Look/Sound-Alike Drug Names
Aricept confused with: Accupril; Aciphex; Anzemet; Aranesp; Azilect
donepezil confused with: benazepril; doxazosin; doxepin; RABEprazole; ramipril
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; no known risk of teratogenicity based on animal data at 6x and 7x MRHD, though risk of fetal death at >1x MRHD
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm, though possible drug excretion into milk based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: 2D6, 3A4 (primary) substrate
Excretion: urine 57% (17% unchanged), feces 15%; Half-life: 70h
Subclass: Cholinesterase Inhibitors, Neurologic ; Dementia/Alzheimer Disease
Mechanism of Action
reversibly binds to and inactivates acetylcholinesterase
Formulary .
No Formulary Selected
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