Donepezil: a clinical review of current and emerging indications

Abstract

This article reviews the piperidine derivative, donepezil hydrochloride (E2020, Aricept^®), a reversible central acetylcholinesterase inhibitor currently approved for treatment of mild-to-moderate Alzheimer’s disease. Donepezil is well absorbed orally, unaffected by food or by time of administration; it reaches therapeutic levels in doses of 5 – 10 mg/day and peak plasma concentrations are obtained 3 – 4 h after oral administration. A single bedtime dose is recommended due to the long elimination half-life of the drug (70 h). Donepezil does not cause liver toxicity or significant drug interactions and is relatively well-tolerated. Initial side effects include nausea, vomiting, diarrhoea, insomnia, muscle cramps, fatigue, anorexia and syncope. Caution is advised in patients with bradycardia. Long-term use of donepezil in AD has been found to delay nursing-home placement and to result in caregiver respite. Donepezil also slows deterioration of cognition and global function in patients with moderate-to-severe AD, with improvement of abnormal behaviours. In addition to AD, donepezil demonstrates significant improvement in cognition, global function and activities of daily living in comparison with placebo-treated patients with vascular dementia and has potential therapeutic benefit for other neurological conditions.

• aphasia
• Alzheimer’s disease
• autism
• cholinesterase inhibitors
• cholinergic transmission
• dementia
• donepezil
• drowsiness
• Down’s syndrome
• head injury
• Lewy body
• memory
• migraine
• opioid drowsiness
• Parkinson’s disease
• schizophrenia
• seizures
• stroke
• tardive dyskinesia
• vascular dementia