Holding Aricept for 3 Days is Safe
Donepezil can be stopped abruptly without requiring a tapering schedule, so holding it for 3 days poses no safety concerns from a withdrawal or discontinuation standpoint. 1
Key Safety Considerations
No Withdrawal Protocol Required
- The American Academy of Family Physicians explicitly states that donepezil can be discontinued abruptly without any established tapering protocol, as there is no withdrawal syndrome associated with this medication 1
- This means a 3-day hold will not cause any acute adverse effects related to stopping the medication 1
Expected Effects During the Hold Period
- You should expect no immediate clinical deterioration during a 3-day hold - the medication's benefits relate to slowing cognitive decline over weeks to months, not maintaining acute function day-to-day 1
- Donepezil reaches steady-state concentration in 15-21 days with daily dosing, so a brief interruption will not immediately reverse therapeutic effects 2
- The drug is absorbed slowly but completely, with peak plasma levels in 3-4 hours, meaning it has a relatively long duration of action that provides some buffer during brief holds 2
Clinical Context for the Hold
The most common reasons for temporarily holding donepezil include:
- Perioperative management - cholinergic effects may interact with anesthesia 3
- Acute gastrointestinal illness - to avoid exacerbating nausea, vomiting, or diarrhea (the most common side effects with relative risks of 2.54 and 2.57 respectively) 3
- Switching between cholinesterase inhibitors - though one study showed no difference between 3-day and 7-day washout periods when switching from donepezil to galantamine 3
Restarting After the Hold
- Resume at the same dose after 3 days without retitration - the brief interruption does not require restarting the dose escalation process 3
- The standard dosing is 5 mg once daily initially, increased to 10 mg after 4-6 weeks if tolerated 3
- Since 70-80% of gastrointestinal adverse effects occur within the first 2 weeks and 60-65% resolve within the first month, a 3-day hold will not reset this tolerance window 4
Important Caveats
- Do not confuse the safety of a brief hold with the advisability of long-term discontinuation - stopping donepezil permanently will result in gradual worsening of cognitive function over subsequent weeks as the modest benefits (approximately 7 points on neuropsychological tests, equivalent to delaying decline by about one year) are lost 1
- Monitor for any acute changes if the hold is related to medical illness, but these would be due to the underlying condition rather than donepezil withdrawal 1