Known brand names include Aricept.
A once-daily tablet or orally disintegrating tablet for dementia of the Alzheimer type, at mild, moderate, or severe stages. It blocks the enzyme that breaks down acetylcholine, a chemical messenger in the brain, which can ease symptoms but has not been shown to change the course of the disease.
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Donepezil and other cholinesterase inhibitors are not on the ISMP acute care high-alert list.
Sources: [1]
The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
Sources: [1]
Atropine, a tertiary anticholinergic, is the antidote: IV atropine sulfate titrated to effect, starting with 1.0 to 2.0 mg IV. Overdose causes cholinergic crisis with slow heart rate, low blood pressure, severe nausea and vomiting, drooling, sweating, depressed breathing, collapse, and seizures; rising muscle weakness can be fatal if breathing muscles are involved. Give general supportive care. Quaternary anticholinergics such as glycopyrrolate have caused atypical blood pressure and heart rate responses with other cholinomimetics, and whether dialysis removes donepezil is unknown.
Sources: [1]
Doses come from the FDA label. Study tool, not for clinical decisions.
No adjustment. In 11 patients with moderate to severe renal impairment, clearance did not differ from matched healthy subjects.
Sources: [1]
No dose adjustment is given. In stable alcoholic cirrhosis, clearance fell by 20% compared with healthy subjects.
Sources: [1]
A reversible acetylcholinesterase inhibitor. Slowing acetylcholine hydrolysis raises acetylcholine levels and is thought to enhance cholinergic transmission, which is deficient in Alzheimer disease; there is no evidence it alters the underlying disease. Half-life is about 70 hours with steady state within 15 days; it is metabolized by CYP2D6, CYP3A4, and glucuronidation, and about 17% of a dose is excreted unchanged in urine.