Donepezil

AChE Inhibitor·Neurology - Anti-Parkinson & Cognitive

Mild, moderate, and severe Alzheimer's dementia

Authority requiredPBSCOGNITIVEAricept5 mg tablet+2

Max Dose

10 mg/day

Half-life

70 h

Bradycardia

RISK

Vivid Dreams

COMMON

Rapid Summary

Overview

Central acetylcholinesterase (AChE) inhibitor. Increases acetylcholine in the brain to delay cognitive decline in Alzheimer's disease.

Maximum Dose

Max 10 mg/day.

Clinical Focus

Enhancing acetylcholine systemically slows the heart and stimulates the gut. High risk of bradycardia, syncope, and severe diarrhea.

Bottom Line

Donepezil is the first-line cholinesterase inhibitor for mild-moderate Alzheimer's disease, but provides only modest symptomatic benefit and causes GI side effects and bradycardia.

Formulation & Access

Brand Names

Aricept

Oral Routes

Tablets (5 mg, 10 mg).

Prescribing & PBS

Authority Required (PBS). Must have confirmed Alzheimer's diagnosis by a specialist/geriatrician.

Indications & Use

Primary

PBSTGA

Mild, moderate, and severe Alzheimer's dementia.

Clinical Place

Does not cure or stop the disease, but temporarily improves cognition and daily function for 6-12 months.

Quick reference

Class & Role

AChE Inhibitor — Central acetylcholinesterase (AChE) inhibitor.

Route / Formulation

Tablets (5 mg, 10 mg). (Aricept)

Usual Dose & Max

Start PO 5 mg NOCTE. Assess tolerance for 4-6 weeks. Increase to Max 10 mg NOCTE if tolerated.

Key Indication Doses

Alzheimer's Disease: Start PO 5 mg NOCTE. Assess tolerance for 4-6 weeks. Increase to Max 10 mg NOCTE if tolerated. Vivid Dreams: If patient suffers horrific nightmares, switch the dose from NOCTE to the morning (mane).

Best Uses

Donepezil is the first-line cholinesterase inhibitor for mild-moderate Alzheimer's disease, but provides only modest symptomatic benefit and causes GI side effects and bradycardia.

Avoid / Cautions

Sick sinus syndrome, un-paced heart block, active peptic ulcer disease.

Key Risks

Cardiovascular: Bradycardia, AV block, syncope/falls (due to increased vagal tone). Gastrointestinal: Nausea, vomiting, diarrhea, anorexia/weight loss. Neurological: Insomnia, intense vivid dreams/nightmares, muscle cramps.

Key Interactions

Anticholinergics (e.g., Oxybutynin, Amitriptyline, Promethazine). These drugs directly cancel each other out. Prescribing both is irrational and guarantees clinical failure. Beta-blockers, Amiodarone (additive bradycardia/syncope).

Monitoring

Monitor HR. Assess weight and appetite regularly in the frail elderly. Baseline ECG to check for heart block prior to initiation.

Clinical Pearl

Donepezil increases REM sleep density. Prescribing it at night causes incredibly vivid, often terrifying dreams in dementia patients. Moving the dose to breakfast cures the nightmares immediately.

Access

Authority requiredAricept5 mg tablet

Brand: Aricept
PBS status: Authority required
Formulation: Tablets (5 mg, 10 mg)

Donepezil

AChE Inhibitor·Neurology - Anti-Parkinson & Cognitive

Mild, moderate, and severe Alzheimer's dementia

Authority requiredPBSCOGNITIVEAricept5 mg tablet+2

Max Dose

10 mg/day

Half-life

70 h

Bradycardia

RISK

Vivid Dreams

COMMON

Rapid Summary

Overview

Central acetylcholinesterase (AChE) inhibitor. Increases acetylcholine in the brain to delay cognitive decline in Alzheimer's disease.

Maximum Dose

Max 10 mg/day.

Clinical Focus

Enhancing acetylcholine systemically slows the heart and stimulates the gut. High risk of bradycardia, syncope, and severe diarrhea.

Bottom Line

Donepezil is the first-line cholinesterase inhibitor for mild-moderate Alzheimer's disease, but provides only modest symptomatic benefit and causes GI side effects and bradycardia.

Formulation & Access

Brand Names

Aricept

Oral Routes

Tablets (5 mg, 10 mg).

Prescribing & PBS

Authority Required (PBS). Must have confirmed Alzheimer's diagnosis by a specialist/geriatrician.

Indications & Use

Primary

PBSTGA

Mild, moderate, and severe Alzheimer's dementia.

Clinical Place

Does not cure or stop the disease, but temporarily improves cognition and daily function for 6-12 months.

Quick reference

Class & Role

AChE Inhibitor — Central acetylcholinesterase (AChE) inhibitor.

Route / Formulation

Tablets (5 mg, 10 mg). (Aricept)

Usual Dose & Max

Start PO 5 mg NOCTE. Assess tolerance for 4-6 weeks. Increase to Max 10 mg NOCTE if tolerated.

Key Indication Doses

Best Uses

Donepezil is the first-line cholinesterase inhibitor for mild-moderate Alzheimer's disease, but provides only modest symptomatic benefit and causes GI side effects and bradycardia.

Avoid / Cautions

Sick sinus syndrome, un-paced heart block, active peptic ulcer disease.

Key Risks

Key Interactions

Monitoring

Monitor HR. Assess weight and appetite regularly in the frail elderly. Baseline ECG to check for heart block prior to initiation.

Clinical Pearl

Donepezil increases REM sleep density. Prescribing it at night causes incredibly vivid, often terrifying dreams in dementia patients. Moving the dose to breakfast cures the nightmares immediately.

Access

Authority requiredAricept5 mg tablet

Brand: Aricept
PBS status: Authority required
Formulation: Tablets (5 mg, 10 mg)