Donepezil T300 26-27

Donepezil

Aricept, Adlarity

Donepezil Drug Class

Central Cholinesterase Inhibitor

Donepezil Dosage Forms

Oral Tablet: 5 mg, 10 mg, 23 mg;

Oral Disintegrating Tablet: 5 mg, 10 mg;

Transdermal Patch: 5 mg/d, 10 mg/d

Donepezil Dosing By Indication

1. Alzheimer disease: 5 mg po daily HS, may titrate to max 10 mg/d or 5 mg/d patch q 7 d, may increase to 10 mg/d after 4-6 wk

2. Dementia: 5 mg po daily HS, may titrate to 10 mg/d at 4-6 wk to max 23 mg/d (immediate-release tablet) or 10 mg/d (disintegrating tablet)

Donepezil Off Label Uses

1. Multi-infarct dementia: 5-10 mg po daily HS

Donepezil MOA

This drug enhances the action of acetylcholine by reversibly inhibiting acetylcholinesterase (AChE), the enzyme responsible for its hydrolysis. It has a high degree of selectivity for AChE in the CNS, which might explain the relative lack of peripheral side effects.

Donepezil Common Adverse Effects

Asthenia, diarrhea, nausea

Donepezil Efficacy Monitoring Parameters

Improvement in symptoms of Alzheimer-type dementia; however, only slowed decline rather than improvement may be seen.

Donepezil Safety Monitoring Parameters

Symptoms of active or occult GI bleeding, particularly if patient has history of ulcer disease or is receiving concomitant NSAIDs. Monitor for bradycardia, particularly in patients with sick-sinus syndrome or conduction abnormalities. Monitor weight and appetite.

Donepezil Key Counseling Points

Take at bedtime, with or without food. Allow disintegrating tablet to dissolve on tongue and follow with a glass of water. Additionally, the 23 mg immediate-release tablet should be swallowed whole and not divided, chewed, or crushed due to the tablet coat. The transdermal patch should be stored in the fridge until use. When applying the patch, ensure it reaches room temperature prior to applying. Adverse effects may be more frequent at dose escalation and tend to resolve with continued use. Report signs/symptoms of GI bleeding.

Donepezil Clinical Pearls

Safety and effectiveness not established in children. No evidence suggests that donepezil alters the course of Alzheimer disease. Also available in a combination product with memantine (Namzaric). When converting from oral formulations to the patch, those on 5 mg po daily can be switched to the 5 mg patch. Discontinuation may result in worsening cognitive function, titrate slowly if discontinuing.