Donepezil (Aricept) Prescription Guidelines for Alzheimer's Disease
For patients with Alzheimer's disease, donepezil should be prescribed starting at 5 mg once daily in the evening, then increased to 10 mg daily after 4-6 weeks if tolerated. 1
Dosing Regimen
Initial Dosing
- Start with 5 mg once daily in the evening, just prior to retiring 2, 1
- Take with or without food 1
- Continue this dose for 4-6 weeks before considering dose increase 1
Dose Titration
- After 4-6 weeks on 5 mg daily, increase to 10 mg once daily if tolerated 1
- 10 mg daily is the maximum recommended dose for mild to moderate Alzheimer's disease 1
- For moderate to severe Alzheimer's disease, may increase to 23 mg daily after at least 3 months on 10 mg daily 1
Administration Instructions
- Administer in the evening, just before bedtime 1
- Can be taken with or without food 1
- The 23 mg tablet (if prescribed) should not be split, crushed, or chewed 1
Monitoring and Follow-up
- Assess response after 6-12 months of treatment 3
- Look for:
- Stabilization or slowing of cognitive decline
- Improvement or stabilization in functional abilities
- Changes in behavior
- Caregiver reports of improvement
Managing Side Effects
- Common side effects include nausea, vomiting, and diarrhea 2, 1
- Side effects are typically mild and transient 4
- Side effects are more common with the 10 mg dose than with 5 mg 1
- To minimize side effects:
Special Considerations
- Donepezil may exaggerate succinylcholine-type muscle relaxation during anesthesia 1
- May cause bradycardia or heart block due to vagotonic effects 1
- Contraindicated in patients with known hypersensitivity to donepezil or piperidine derivatives 1
Expected Benefits
- Modest improvement in cognition and global function 2, 6
- Approximately 20-35% of patients show a clinically meaningful response 2
- Benefits may include temporary stabilization of cognition or reduction in rate of cognitive decline 2
- Efficacy has been demonstrated in mild, moderate, and severe Alzheimer's disease 1
Patient/Caregiver Education
- Communicate expected modest benefits before starting treatment 2
- Explain that donepezil treats symptoms but does not alter disease progression
- Advise that initial improvement may be seen as early as 3 weeks after starting treatment 4
- Inform that maximum benefit may take several months to achieve
By following this structured approach to prescribing donepezil, you can optimize treatment outcomes while minimizing adverse effects in patients with Alzheimer's disease.