Formulary
Donepezil hydrochloride: Indications, Dosing, Side Effects and Interactions
Donepezil is a reversible inhibitor of acetylcholinesterase.
MedNext Academy | 3 min read
Donepezil hydrochloride: Indications, Dosing, Side Effects and Interactions
Donepezil is a reversible inhibitor of acetylcholinesterase.
Drug action
Donepezil is a reversible inhibitor of acetylcholinesterase.
Indications and dose
**Mild to moderate dementia in Alzheimer's disease**
- **Adult** (By Mouth): Initially 5 mg once daily for one month, then increased if necessary up to 10 mg daily, doses to be given at bedtime.
Cautions
Asthma; chronic obstructive pulmonary disease; sick sinus syndrome; supraventricular conduction abnormalities; susceptibility to peptic ulcers Cautions, further information Elderly For acetylcholinesterase inhibitors, Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate 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).
Side effects
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 Arrhythmias; gastrointestinal haemorrhage; hypersalivation; seizure Rare or very rare Cardiac conduction disorders; hepatic disorders; movement disorders; neuroleptic malignant syndrome (discontinue-potentially fatal); rhabdomyolysis Frequency not known QT interval prolongation; sexual dysfunction Side-effects, further information Dose should be started low and increased if tolerated and necessary.
Interactions
**Other interactions (8):**
- Donepezil hydrochloride and/or any of its metabolites do not inhibit the metabolism of theophylline, warfarin, cimetidine or digoxin in humans.
- The metabolism of donepezil hydrochloride is not affected by concurrent administration of digoxin or cimetidine.
- Drug interaction studies performed in vitro show that ketoconazole and quinidine, inhibitors of CYP3A4 and 2D6 respectively, inhibit donepezil metabolism.
- Therefore, these and other CYP3A4 inhibitors, such as itraconazole and erythromycin, and CYP2D6 inhibitors, such as fluoxetine could inhibit the metabolism of donepezil.
- In a study in healthy volunteers, ketoconazole increased mean donepezil concentrations by about 30%.
- Enzyme inducers, such as rifampicin, phenytoin, carbamazepine and alcohol may reduce the levels of donepezil.
Hepatic impairment
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.
Medicinal forms
Suspension,Tablet,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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