Pre-Treatment Testing for Donepezil
No specific laboratory tests or baseline investigations are required before starting donepezil for Alzheimer's disease. Unlike tacrine (which requires liver function monitoring) or clozapine (which requires extensive blood work), donepezil is not hepatotoxic and does not necessitate routine laboratory monitoring prior to initiation 1.
What Should Be Done Before Starting Donepezil
Clinical Assessment Only
- Confirm the diagnosis of probable Alzheimer's disease through appropriate clinical evaluation before initiating treatment 1
- Assess baseline cognitive function using standardized measures (such as ADAS-Cog or MMSE) to allow for monitoring of treatment response 1
- Evaluate baseline global clinical state to track changes over time 1
No Routine Laboratory Testing Required
- Donepezil does not require liver function tests before initiation, as it is not hepatotoxic unlike tacrine 1
- No baseline blood work is mandated for donepezil therapy 1
- No ECG monitoring is specifically required prior to starting donepezil 1
Important Distinctions from Other Medications
Contrast with Tacrine
- Tacrine requires liver function tests every other week for 16 weeks, then every 3 months due to hepatotoxicity risk 1
- This monitoring burden is not necessary with donepezil, making it a more practical first-line cholinesterase inhibitor 1
Medication Review
- Assess for potential drug interactions with concomitant medications, particularly cimetidine, theophylline, warfarin, and digoxin, though evidence for interactions is conflicting 1
- Review current medications to identify any that might interact with cholinergic therapy 1
Clinical Pitfalls to Avoid
- Do not delay treatment waiting for unnecessary laboratory tests, as no specific blood work is required 1
- Do not confuse donepezil requirements with those of tacrine or other medications that do require baseline testing 1
- Ensure patients and families understand the expected modest benefits (approximately 2-3 points on ADAS-Cog scale) before starting therapy 1