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donepezil (Rx)Brand and Other Names:Aricept, Aricept ODT

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 23mg

tablet, oral disintegrating

  • 5mg
  • 10mg
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Alzheimer's Disease

Dementia of the Alzheimer's type

Mild to moderate

  • 5 mg PO qHS initially, may increase to 10 mg/day after 4-6 weeks if warranted

Moderate to severe

  • 5 mg PO qHS initially, may increase to 10 mg qDay after 4-6 weeks; may further increase to 23 mg/day after 3 months if warranted

Administration

Take at bedtime before retiring

Take with or without food

ODT: Dissolve on tongue and follow with water

Dose Modification

Renal Impairment

  • Not studied

Hepatic Impairment

  • Not studied

Not recommended

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Interactions

Interaction Checker

donepezil and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Nausea (3-19%)

            Diarrhea (5-15%)

            Insomnia (2-14%)

            Accident (7-13%)

            Infection (11%)

            1-10%

            Headache (3-10%)

            Vomiting (3-8%)

            Cramping (3-8%)

            Fatigue (3-8%)

            Anorexia (2-8%)

            Hypertension (3% )

            Abnormal dreams (3%)

            Hallucinations (3%)

            Confusion (2%)

            Syncope (2%)

            Postmarketing reports

            Abdominal pain, agitation, aggression, cholecystitis, convulsions, heart block (all types), hemolytic anemia, hepatitis, hyponatremia, neuroleptic malignant syndrome, pancreatitis, rash, rhabdomyolysis, QTc prolongation, Stevens Johnson syndrome toxic epidermal necrolysis and torsade de pointes

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            Warnings

            Contraindications

            Hypersensitivity to donepezil or to piperidine derivatives

            Cautions

            Risk of GI bleed, especially in patients with history of gastric ulcer or those on NSAIDs

            Cholinesterase inhibitors are likely to exaggerate succinylcholine-type muscle relaxation during anesthesia

            Cholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes manifesting as bradycardia or heart block

            Can cause vomiting (higher risk with dose of 23 mg/day)

            May cause anorexia and/or weight loss (dose dependent)

            Cholinomimetics may cause bladder outflow obstructions

            Cholinomimetics are believed to have some potential to cause generalized convulsions

            Cholinesterase inhibitors should be prescribed with care with history of asthma or obstructive pulmonary disease

            Use with caution in patients with history of seizure disorders, urinary tract obstruction, peptic ulcer disease, cardiac conduction abnormalities, or respiratory disease including COPD or asthma

            May be associated with QT prolongation and torsades de pointes; use caution in patients at risk of cardiac repolarization

            Rare cases of neuroleptic malignant syndrome reported; may consider discontinuing therapy if symptoms occur

            Rare cases of rhabdomyolysis reported following few months of therapy or following therapy initiation; use caution in patients with risk factors rhabdomyolysis, including medications associated with rhabdomyolysis; consider discontinuing therapy if marked elevation of CPK levels or symptoms suggesting rhabdomyolysis occur

            Low weight patients <55 kg may experience more weight loss, nausea, and vomiting than patients >55 kg

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Excretion in breast milk unknown, use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Acetylcholinesterase inhibitor that causes an increase in concentrations of acetylcholine, which in turn enhances cholinergic neurotransmission

            Absorption

            Bioavailability: 100%

            Peak plasma time: 3-4 hr

            Distribution

            Protein bound: 96%

            Vd: 12-16 L/kg

            Metabolism

            Hepatic P-450 enzymes CYP2D6, CYP3A4

            Metabolites: 4 major metabolites, 2 active

            Elimination

            Half-life: 70 hr

            Total body clearance: 0.13 L/hr/kg

            Excretion: Urine (57%), feces (17%)

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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