From the Guidelines
Donepezil should be initiated at a dosage of 5 mg per day and increased to 10 mg per day after four weeks, as this dosing regimen has been shown to produce clinically meaningful improvements in cognitive and global function in patients with mild to moderate Alzheimer’s disease. The recommended dosing for Donepezil (Aricept) is based on the guidelines for managing Alzheimer's disease, which suggest that the medication be given once daily, starting with a dosage of 5 mg per day, and increased to 10 mg per day (maximum dosage) after four weeks 1. Some key points to consider when prescribing Donepezil include:
- The medication is not hepatotoxic
- Adverse effects are typically mild, such as nausea, vomiting, and diarrhea, and can be reduced by taking the medication with food
- Some patients may exhibit an initial increase in agitation, which subsides after the first few weeks of therapy
- Efficacy has been apparent over up to 4.9 years, making it a viable long-term treatment option for patients with Alzheimer's disease 1. It is essential to monitor patients for potential side effects and adjust the dosage accordingly, as the 10 mg dose is considered the maximum effective dose for most patients with Alzheimer's disease.
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. The maximum recommended dosage of donepezil hydrochloride tablets in patients with mild to moderate Alzheimer’s disease is 10 mg per day A dose of 10 mg should not be administered until patients have been on a daily dose of 5 mg for 4 to 6 weeks.
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 maximum recommended dosage of donepezil hydrochloride tablets in patients with moderate to severe Alzheimer’s disease is 23 mg per day A dose of 10 mg should not be administered until patients have been on a daily dose of 5 mg for 4 to 6 weeks. A dose of 23 mg per day should not be administered until patients have been on a daily dose of 10 mg for at least 3 months.
The recommended dosing for Donepezil (Aricept) is:
- Starting dose: 5 mg once per day in the evening
- Maximum dose for mild to moderate Alzheimer's disease: 10 mg per day
- Maximum dose for moderate to severe Alzheimer's disease: 23 mg per day
- Dose titration:
- 10 mg dose should not be administered until patients have been on 5 mg for 4 to 6 weeks
- 23 mg dose should not be administered until patients have been on 10 mg for at least 3 months 2
From the Research
Recommended Dosing for Donepezil (Aricept)
The recommended dosing for Donepezil (Aricept) is as follows:
- Initial dose: 5 mg daily, taken at bedtime 3, 4
- Dose increase: to 10 mg daily after 4-6 weeks, according to patient response and tolerance 3, 4
- Higher doses: 15 mg/day and 20 mg/day have been studied, with some patients tolerating these doses well 5
- Dose titration: may be recommended for patients with moderate to severe Alzheimer's disease, to reduce cholinergic side effects 6
Key Considerations
- Donepezil is generally well-tolerated, with most adverse events being mild and transient 7, 3, 4
- Common side effects include nausea, diarrhea, anorexia, and vomiting, which are most likely to occur during dose initiation or adjustment 7, 3, 4
- Caution is advised in patients with bradycardia 4
- Donepezil does not cause liver toxicity or significant drug interactions 3, 4