Related Subjects:
|Dementias
|Abbreviated Mental Test Score (AMTS)
|Alzheimer disease
|Dementia with Lewy bodies
|Frontotemporal dementia
|Corticobasal degeneration
|Creutzfeldt Jakob disease
|Vascular Dementia
|Primary progressive aphasia
|Anti Dementia Drugs
|AIDS Dementia Complex
|Normal Pressure Hydrocephalus
|Acetylcholinesterase inhibitors
|Mental Capacity Act 2005
|Behavioural and Psychological Symptoms of Dementia
💡 Cholinesterase inhibitors like Donepezil do not prevent disease progression, but they may temporarily improve or stabilise symptoms.
Always follow BNF guidance and local protocols. Liaise with Geriatricians, Psychogeriatricians, or Neurologists before starting.
⚠️ Side effects are significant, so initiation must be carefully considered.
⚙️ Mode of Action
- Acetylcholinesterase inhibitor (AChEI) → prevents breakdown of acetylcholine
- Increases cholinergic transmission at muscarinic & nicotinic receptors
- Aims to improve cognition and function in dementia
📌 Indications
- Mild to moderately severe Alzheimer’s disease
- Dementia with Lewy bodies
- Parkinson’s disease dementia
- Vascular or mixed dementia (select cases)
💊 Dosing – Donepezil (check BNF)
| Regimen |
Details |
| 🌙 Starting dose |
• 5 mg PO once daily at night
|
| ⬆️ Maintenance |
• Increase to 10 mg PO once daily
• Only after ≥4 weeks at starting dose, if tolerated
|
🔄 Interactions
- Metabolised by CYP450 → affected by enzyme inducers and inhibitors
- Inducers (↓ effect): Phenytoin, Carbamazepine
- Inhibitors (↑ effect/toxicity): Erythromycin, Paroxetine, Fluoxetine
🚫 Contraindications
- Sick sinus syndrome or other conduction defects
- Asthma or obstructive pulmonary disease
⚠️ Cautions
- Monitor for falls
- If pulse <50 bpm: stop donepezil and any concurrent beta-blocker, obtain ECG
- Use cautiously in extrapyramidal disease and peptic ulcer disease
🔄 Alternatives if Not Tolerated
- Switch to another AChEI (e.g., Rivastigmine, Galantamine)
- Consider Memantine as an alternative
❗ Side
