Acetylcholinesterase inhibitor (AChEI) — dementia

Donepezil

Brand names: Aricept

Used in: Delirium & Cognitive Impairment

Donepezil is an acetylcholinesterase inhibitor used to treat the symptoms of Alzheimer's disease.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Mild to Moderate Alzheimer's Disease: 5 mg to 10 mg once daily ( 2.1 ) Moderate to Severe Alzheimer's Disease: 10 mg to 23 mg once daily ( 2.2 ) 2.1 Dosing in Mild to Moderate Alzheimer’s Disease The recommended starting dosage of donepezil hydrochloride tablet is 5 mg administered once per day in the evening, just prior to retiring. The maximum recommended dosage of donepezil hydrochloride tablets in patients with mild to moderate Alzheimer's disease is 10 mg per day. A dose of 10 mg should not be administered until patients have been on a daily dose of 5 mg for 4 to 6 weeks. 2.2 Dosing in Moderate to Severe Alzheimer’s Disease The recommended starting dosage of donepezil hydrochloride …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-11-29. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It inhibits acetylcholinesterase, increasing acetylcholine availability to support cognition; it eases symptoms rather than altering the underlying disease.

Prescribing in practice

Cholinergic effects (nausea, diarrhoea, bradycardia, syncope) occur — use caution in cardiac conduction problems, active peptic ulcer disease and significant airways disease.
It is usually taken at night.
Review benefit periodically.

Monitoring

Review cognition and function, heart rate and gastrointestinal tolerance; consider an ECG if bradycardia or syncope occurs.

Counselling the patient

Nausea or vivid dreams can occur and often settle.
Report fainting, a slow pulse, or significant weight loss.
It manages symptoms but does not cure the condition.

Evidence & guidelines

Recommended for Alzheimer's disease per NICE NG97/TA217.

Reference: NICE TA217 Dementia; NICE NG97 Dementia; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways