Acetylcholinesterase Inhibitor Pregnancy: Avoid — no data

Donepezil

Brand names: Aricept

Adult dose

Dose: Starting: 5 mg OD at night × 4 weeks, then 10 mg OD at night. Moderate-severe: may increase to 23 mg OD (specialist).

Route: Oral

Frequency: Once daily at bedtime

Max: 23 mg OD (specialist use); standard 10 mg OD

For Alzheimer's disease (mild-moderate-severe). Take at bedtime — anticholinergic side effects and insomnia if taken in the morning. NICE TA217: first-line for mild-moderate AD.

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed in children

Not applicable in paediatric patients

Dose adjustments

Renal

No dose adjustment required

Hepatic

Caution in hepatic impairment — reduce dose if significant

Clinical pearls

NICE TA217: donepezil, rivastigmine, galantamine recommended for mild-moderate AD
Bedtime dosing: reduces nausea and insomnia side effects — always prescribe at night
Cholinergic bradycardia: check resting HR and ECG before starting — relevant for patients with sick sinus syndrome
Nightmares: switch to morning dosing if persistent (trade-off with insomnia risk)

Contraindications

Hypersensitivity to piperidine derivatives

Side effects

Nausea/vomiting (common — take with food)
Diarrhoea
Insomnia (take at bedtime)
Nightmares (often resolves)
Bradycardia (check ECG in cardiac patients)
Muscle cramps
Syncope
GI haemorrhage (ulcerogenic — use PPI if NSAIDs co-prescribed)

Interactions

Beta-blockers — additive bradycardia
Anticholinergic drugs — reduced donepezil efficacy (compete)
NSAIDs — increased GI bleeding risk (both are ulcerogenic)
QT-prolonging drugs — donepezil has mild QT risk

Monitoring

Cognitive assessments (MMSE, MOCA at 3 and 6 months)
Heart rate and ECG
GI symptoms
Weight and nutritional status

Reference: BNFc; BNF; NICE TA217; UK Dementia Prevention Commission. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

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