Aricept (donepezil hydrochloride) is a prescription acetylcholinesterase inhibitor specifically formulated for the treatment of dementia of the Alzheimer’s type. It functions by increasing acetylcholine levels in the brain, a neurotransmitter critical for memory, attention, reasoning, and language. Clinically proven to slow cognitive decline, Aricept helps patients maintain functional abilities for a longer duration, providing meaningful symptomatic relief in mild, moderate, and severe Alzheimer’s disease. This agent is one of the most extensively studied and widely prescribed medications in its class, supported by robust clinical trial data and decades of real-world use.

Features

• Active ingredient: Donepezil hydrochloride
• Available in 5 mg and 10 mg oral tablets, and 23 mg extended-release tablets
• Once-daily dosing regimen for patient convenience
• FDA-approved for all stages of Alzheimer’s disease
• Demonstrated efficacy in improving cognition, function, and global clinical state
• Well-established safety profile with extensive post-marketing surveillance

Benefits

• Slows the progression of cognitive decline in Alzheimer’s patients
• Helps maintain activities of daily living, promoting greater independence
• Improves or stabilizes neuropsychiatric symptoms such as apathy and agitation
• Enhances global functioning and quality of life for both patients and caregivers
• Supports long-term treatment with a predictable pharmacokinetic profile
• May delay the need for nursing home placement

Common use

Aricept is indicated for the treatment of dementia associated with Alzheimer’s disease. It is used in mild, moderate, and severe cases to address core symptoms such as memory loss, confusion, and impaired judgment. Clinicians may also consider its use in related dementias where cholinergic deficit is evident, though such use is off-label. Treatment is typically initiated early in the disease course to maximize therapeutic benefits, and may be continued as long as a meaningful clinical response is observed.

Dosage and direction

The recommended starting dosage for Aricept is 5 mg administered orally once daily, preferably at bedtime. After 4–6 weeks, the dose may be increased to 10 mg once daily if well tolerated. For patients with moderate to severe Alzheimer’s disease who have been on 10 mg daily for at least 3 months, a 23 mg once-daily tablet may be considered for additional benefit, though with increased monitoring for side effects. Tablets should be swallowed whole, with or without food. Dosage adjustments are necessary in patients with hepatic impairment; use in severe renal impairment is not recommended.

Precautions

Patients taking Aricept should be monitored for gastrointestinal effects, including nausea, vomiting, and diarrhea, especially during dose escalation. Caution is advised in those with a history of ulcer disease, asthma, COPD, or cardiac conduction abnormalities. Aricept may cause bladder outflow obstruction or seizures in susceptible individuals. Weight should be monitored periodically due to risk of anorexia. Anesthesia providers should be informed of Aricept use prior to surgery due to potential for exaggerated neuromuscular blockade.

Contraindications

Aricept is contraindicated in patients with known hypersensitivity to donepezil hydrochloride or any components of the formulation. It is also contraindicated in those with a history of serious skin reactions such as Stevens-Johnson syndrome. The 23 mg tablet is contraindicated in patients who have not first been stabilized on 10 mg daily dosing.

Possible side effects

Common side effects (>5%) include nausea, diarrhea, insomnia, vomiting, muscle cramps, fatigue, and anorexia. Less frequently, patients may experience dizziness, bradycardia, syncope, weight loss, or vivid dreams. Serious but rare adverse reactions include gastrointestinal bleeding, seizures, QT prolongation, and extrapyramidal symptoms. Most side effects are dose-dependent and often transient.

Drug interaction

Aricept may interact with anticholinergic agents, potentially reducing its efficacy. Concomitant use with cholinergic agonists (e.g., bethanechol) or other acetylcholinesterase inhibitors may increase cholinergic effects. Drugs that inhibit CYP2D6 and CYP3A4 (e.g., ketoconazole, quinidine) may increase donepezil concentrations. Use with beta-blockers or non-dihydropyridine calcium channel blockers may increase the risk of bradycardia. NSAIDs may increase the risk of gastrointestinal bleeding.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose is not recommended.

Overdose

Overdose with Aricept can lead to severe cholinergic crisis characterized by nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, collapse, and convulsions. General supportive measures should be instituted. Intravenous atropine sulfate titrated to effect is the antidote of choice, with an initial dose of 1 to 2 mg IV, with subsequent dosing based on clinical response.

Storage

Store Aricept tablets at room temperature (20°–25°C or 68°–77°F), with excursions permitted between 15°–30°C (59°–86°F). Keep in the original container, tightly closed, and protect from moisture and light. Keep out of reach of children and pets.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication regimen. Individual patient responses may vary.

Reviews

Clinical studies and meta-analyses consistently demonstrate that Aricept provides statistically significant benefits in cognition, function, and behavior compared to placebo. Many clinicians report observable improvements in patient engagement and caregiver burden. However, responses are variable, and not all patients experience the same degree of benefit. Long-term use is generally well tolerated, though side effects may lead to discontinuation in some cases.