Crushing Donepezil Tablets
Donepezil 23 mg tablets should NOT be crushed, split, or chewed and must be swallowed whole, while the 5 mg and 10 mg tablets can be crushed if necessary for patients with swallowing difficulties. 1
FDA-Approved Administration Guidelines
The FDA drug label provides explicit instructions that differ by tablet strength:
- 23 mg tablets: Must be swallowed whole without splitting, crushing, or chewing 1
- 5 mg and 10 mg tablets: The FDA label states these "can be taken with or without food" but does not prohibit crushing these lower-strength formulations 1
Practical Administration for Dysphagia
For geriatric patients with dementia who have difficulty swallowing:
- Use the 5 mg or 10 mg tablet formulations if crushing is necessary, as these are standard immediate-release tablets 1
- Administer with food to reduce gastrointestinal side effects (nausea, vomiting, diarrhea) which are the most common adverse effects 2, 1
- Give once daily in the evening to minimize side effects 3
- The medication can be taken with or without food, though taking it with food may reduce both gastrointestinal and potentially behavioral side effects 2, 3
Important Clinical Considerations
Common adverse effects to monitor include nausea, vomiting, diarrhea, nightmares, and bradyarrhythmias 2, 4. These effects can be reduced by:
- Taking donepezil with food 2, 3
- Using gradual dose escalation (starting at 5 mg for 4-6 weeks before increasing to 10 mg) 2, 3
Initial agitation may occur in some patients when starting donepezil, but this typically subsides after a few weeks and should not be confused with sustained anxiety worsening 3, 4
Critical Pitfall to Avoid
Do not use the 23 mg high-dose formulation if the patient requires crushed medication, as this formulation is specifically designed to be swallowed whole and crushing it may alter the pharmacokinetics and increase adverse effects 1. For patients requiring crushed medication, maintain treatment with the 5 mg or 10 mg formulations 1.