What is the recommended dosing schedule for Aricept (donepezil) in a geriatric patient with dementia?

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When to Take Aricept (Donepezil)

Take Aricept once daily in the evening, just prior to bedtime. 1

Standard Dosing Schedule

  • The FDA-approved administration time is in the evening, just before retiring, which is the recommended timing for all doses (5 mg, 10 mg, and 23 mg). 1

  • Aricept can be taken with or without food, providing flexibility in administration while maintaining efficacy. 1

  • The once-daily evening dosing is supported by donepezil's long elimination half-life of approximately 70 hours, which allows for consistent therapeutic levels with a single daily dose. 2

Alternative Timing for Specific Side Effects

  • If insomnia or nightmares occur, switch to morning administration rather than evening dosing. 3

  • This timing adjustment addresses sleep-related adverse effects while maintaining therapeutic benefit, as the long half-life ensures continuous drug levels regardless of administration time. 2

Practical Dosing Considerations

  • Start at 5 mg once daily in the evening, and do not increase to 10 mg until the patient has been on 5 mg for at least 4 to 6 weeks. 1

  • For patients on 10 mg considering escalation to 23 mg, they must remain on 10 mg daily for at least 3 months before increasing. 1

  • Taking the medication with food can help minimize gastrointestinal side effects (nausea, vomiting, diarrhea) without affecting absorption. 4, 1

Common Pitfalls to Avoid

  • Do not split, crush, or chew the 23 mg tablet if prescribed, as this formulation requires intact administration. 1

  • Avoid premature dose escalation before the minimum 4-6 week period on 5 mg, as this increases the risk of adverse events without allowing adequate assessment of tolerability. 1

  • If switching from evening to morning dosing due to sleep disturbances, maintain the once-daily schedule rather than splitting doses, as donepezil is not formulated for twice-daily administration. 3, 2

References

Research

Donepezil: a clinical review of current and emerging indications.

Expert opinion on pharmacotherapy, 2004

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Best Initial Medication for Elderly Patient with Short-Term Memory Loss

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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