From the Guidelines
The recommended starting dose for Donepezil (Aricept) is 5 mg taken orally once daily. This dosage is based on the guidelines for managing Alzheimer's disease, which suggest starting with a low dose to minimize side effects and allow the body to adjust to the medication 1. To implement this:
- Start with 5 mg daily for at least 4 weeks, as this initial period allows for assessment of tolerance and efficacy.
- Take the medication at the same time each day, preferably in the evening, to establish a routine and potentially improve sleep quality.
- It can be taken with or without food, but taking it with food may help reduce gastrointestinal side effects such as nausea, vomiting, and diarrhea. After the initial period, the dose may be increased to 10 mg daily if needed and tolerated, but this should be done under medical supervision to monitor for any adverse effects and ensure the patient continues to derive benefit from the medication. Donepezil is a cholinesterase inhibitor that works by increasing acetylcholine levels in the brain, which can help improve cognitive function in conditions like Alzheimer's disease, as evidenced by studies showing clinically meaningful improvements in cognitive and global function in patients with mild to moderate Alzheimer’s disease 1. It's crucial to note that while donepezil can help manage symptoms, it does not cure or stop the progression of Alzheimer's disease, highlighting the importance of regular follow-ups with a healthcare provider to monitor effectiveness and adjust treatment as needed.
From the FDA Drug Label
2.1 Dosing in Mild to Moderate Alzheimer's Disease The recommended starting dosage of donepezil hydrochloride tablets is 5 mg administered once per day in the evening, just prior to retiring.
2.2 Dosing in Moderate to Severe Alzheimer's Disease The recommended starting dosage of donepezil hydrochloride tablets is 5 mg administered once per day in the evening, just prior to retiring.
The starting dose of Donepezil (Aricept) for treatment is 5 mg administered once per day in the evening, just prior to retiring, for both mild to moderate and moderate to severe Alzheimer’s disease 2.
From the Research
Donepezil Starting Dose
- The initial recommended dosage of Donepezil is 5 mg daily before bedtime, with a dosage increase to 10 mg after four to six weeks according to the patient's response and tolerance 3
- This dosage regimen is supported by studies that have shown Donepezil to be effective and well-tolerated in patients with mild to moderate Alzheimer's disease 3, 4
Dose Optimization
- Higher doses of Donepezil, such as 15 mg/day and 20 mg/day, have been studied in patients with mild to moderate Alzheimer's disease, and have been found to be safe and well-tolerated 5
- A 23-mg once-daily sustained-release dose of Donepezil has also been approved for the treatment of patients with moderate to severe Alzheimer's disease, and has been shown to provide greater benefits in cognition compared to the 10-mg dose 6, 7
Clinical Relevance
- The choice of Donepezil dose should be individualized based on the patient's response and tolerance, as well as the severity of their Alzheimer's disease 6, 7
- Patients with more advanced Alzheimer's disease may benefit from higher doses of Donepezil, such as the 23-mg dose, although this requires further study 7