Acetylcholinesterase inhibitor
Donepezil hydrochloride
Brand names: Aricept
Adult dose
Dose: 5mg OD nocte for 4 weeks; titrate to 10mg OD if tolerated
Route: Oral
Frequency: OD nocte
Clinical pearls
- NICE TA217 dementia: 1st-line for mild–moderate Alzheimer's disease
- Specialist initiation; continued in primary care under shared-care
- Counsel about GI effects in first weeks; bedtime dosing common but morning if vivid dreams
Contraindications
- Severe hepatic impairment
- Hypersensitivity
- Caution in sick sinus syndrome / conduction defects
Side effects
- GI upset (diarrhoea, nausea, vomiting)
- Insomnia
- Vivid dreams
- Bradycardia / syncope
- Urinary incontinence
- Muscle cramps
- QT prolongation (rare)
- Seizures
- Neuroleptic malignant syndrome (rare)
Interactions
- Beta-blockers (bradycardia)
- Antimuscarinics (antagonism)
- Strong CYP3A4/2D6 inhibitors
Monitoring
- Cognitive response (MMSE/ACE-III) at 3–6 months
- HR / ECG if bradycardia risk
- Falls assessment
Reference: BNF; NICE TA217; NICE NG97 dementia; https://bnf.nice.org.uk/drugs/donepezil-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
- BALL Score for Relapsed/Refractory CLL · Leukaemia
Pathways
- Acute Behavioural Disturbance / Rapid Tranquillisation · RCEM 2022; RCPsych 2022; NICE NG10
- Self-Harm Presentation · NICE NG225 (2022)
- Capacity Assessment (Mental Capacity Act) · MCA 2005; Code of Practice
- Acute Psychosis Management · NICE CG178 2014
- Depression Management · NICE CG90 2022
- Lithium Therapy Monitoring · NICE CG185 / BNF