Common use
Aricept is the brand name for donepezil, an acetylcholinesterase inhibitor approved to treat the symptoms of Alzheimer’s disease across mild, moderate, and severe stages. By reducing the breakdown of acetylcholine, a key neurotransmitter for learning and memory, Aricept may improve or stabilize cognition, attention, and activities of daily living for some patients. While responses vary, many caregivers notice subtle improvements in organization, conversational ability, or daily engagement after the medication is titrated to a therapeutic dose.
It’s important to understand what Aricept does and does not do. It does not cure dementia or halt the underlying disease process; rather, it provides symptomatic benefit that can help maintain function and quality of life. Benefits may be modest and may take weeks to become apparent. Some clinicians also consider Aricept in certain mixed dementias or dementia with Lewy bodies, but these uses are off-label and should be weighed carefully, especially given potential sensitivity to cholinergic effects in some conditions.
Dosage and direction
Aricept is typically started at 5 mg once daily, often taken in the evening to reduce daytime nausea. After 4 to 6 weeks, many patients are increased to 10 mg once daily if the initial dose is well tolerated and there’s a clinical rationale to do so. For moderate to severe Alzheimer’s disease, a 23 mg extended-release strength exists; this dose is considered only after a patient has tolerated 10 mg daily for at least three months. Decisions to escalate should always be individualized by the prescribing clinician based on benefits, tolerability, comorbidities, and caregiver input.
Aricept may be taken with or without food. Standard tablets should be swallowed whole with water. The orally disintegrating tablet (ODT) is placed on the tongue to dissolve, then swallowed; no water is required. The 23 mg extended-release tablet should not be crushed, chewed, or split. If insomnia or vivid dreams occur with nighttime dosing, some clinicians switch to morning administration; this adjustment should be discussed with the prescriber to ensure safety and adherence.
No routine dose adjustment is usually required for mild to moderate kidney impairment. In hepatic impairment or frail older adults, a slower titration and closer monitoring are prudent. Because Alzheimer’s presentations and caregiver support vary widely, a personalized dosing and follow-up plan is essential to optimize benefits and minimize side effects.
Precautions
Aricept increases cholinergic activity, which can lower heart rate and affect conduction in the heart. Use caution in patients with bradycardia, sick sinus syndrome, atrioventricular block, or those on other rate-slowing drugs (such as certain beta-blockers). Monitor for dizziness, syncope, or falls, particularly during initiation and dose changes. An electrocardiogram may be considered in patients with a cardiac history or overlapping risk factors.
The medication can increase gastric acid secretion and may heighten the risk of gastrointestinal bleeding, especially when combined with NSAIDs (such as ibuprofen, naproxen) or in those with a history of peptic ulcer disease. Report black or tarry stools, vomiting blood, or new abdominal pain promptly. Nausea, vomiting, diarrhea, and decreased appetite are common early in therapy and often improve with time or dose adjustments.
Other cholinergic effects warrant caution in asthma or COPD (potential bronchoconstriction), urinary outflow obstruction (worsening frequency/urgency), and seizure disorders (lowered threshold). Weight loss can occur and should be monitored, especially in underweight or frail individuals. Sleep disturbances, including insomnia and vivid dreams, may emerge; adjusting dose timing can help. During surgery or anesthesia, Aricept can interact with neuromuscular blockers—always inform the surgical team about current therapy.
Pregnancy and breastfeeding data for donepezil are limited. If exposure occurs or therapy is being considered, risks and benefits should be reviewed with a clinician. As with all dementia treatments, shared decision-making that includes the patient whenever possible and the caregiver is central to safe, compassionate care.
Contraindications
Aricept is contraindicated in individuals with known hypersensitivity to donepezil or to piperidine derivatives. Past serious allergic reactions, including rash, hives, angioedema, or anaphylaxis, preclude further use. If any signs of serious skin reactions (such as widespread rash, blistering, or mucosal involvement) occur, stop the medication and seek urgent medical evaluation.
Possible side effects
Common side effects include nausea, vomiting, diarrhea, decreased appetite, weight loss, dizziness, fatigue, muscle cramps, headache, insomnia, and vivid dreams. These are most frequent during the first weeks of therapy or after a dose increase, and many diminish with continued use or by adjusting administration time. Taking with a small snack may ease gastrointestinal symptoms.
Less common but more serious effects can include bradycardia, syncope, atrioventricular block, gastrointestinal bleeding or ulceration, urinary incontinence, seizures, and rare skin reactions (including Stevens-Johnson syndrome). Rhabdomyolysis and neuroleptic malignant syndrome–like reactions have been reported rarely. Seek medical attention if experiencing fainting spells, chest pain, severe abdominal pain, black stools, coughing or vomiting blood, new confusion or agitation beyond baseline, or severe muscle pain and dark urine.
Caregivers play a key role in observing changes. Keeping a simple log of sleep quality, appetite, bowel habits, alertness, mood, and daily function during the first two months can help clinicians judge benefit versus side effects and tailor the plan accordingly.
Drug interactions
Aricept’s effects can be influenced by other medicines. Anticholinergic drugs (such as diphenhydramine, certain bladder antispasmodics like oxybutynin or tolterodine, and some tricyclic antidepressants) may counteract donepezil’s benefits by blocking acetylcholine. Conversely, other cholinergic agents can increase side effects. Caution is warranted with neuromuscular blockers (particularly succinylcholine) used during anesthesia due to prolonged neuromuscular blockade.
Additive bradycardia may occur with beta-blockers (e.g., metoprolol), some calcium channel blockers (e.g., verapamil, diltiazem), digoxin, or amiodarone. Monitor heart rate and symptoms like dizziness or near-syncope when these combinations are unavoidable. Nonsteroidal anti-inflammatory drugs can raise the risk of gastrointestinal bleeding; gastroprotection may be considered for at-risk patients.
Donepezil is metabolized mainly by CYP2D6 and CYP3A4. Potent inhibitors (such as ketoconazole, clarithromycin, fluoxetine, paroxetine, or quinidine) may increase donepezil levels and side effects; dose adjustments or closer monitoring may be needed. Inducers (such as carbamazepine, phenytoin, rifampin, or St. John’s wort) may reduce effectiveness. Because polypharmacy is common in older adults, always provide a complete, up-to-date medication list—including over-the-counter drugs and supplements—at each visit.
Missed dose
If a dose of Aricept is missed, take it as soon as remembered the same day. If it is nearly time for the next dose, skip the missed dose and resume the regular schedule. Do not double up to make up for a missed dose. If several days of doses are missed—particularly more than seven days—consult the prescriber before restarting. Re-titration from a lower dose may be recommended to reduce side effects when resuming therapy.
Overdose
Overdose can lead to a cholinergic crisis, with symptoms such as severe nausea, vomiting, drooling, sweating, slow heart rate, low blood pressure, collapse, difficulty breathing, muscle weakness, and seizures. This is a medical emergency. In the United States, call Poison Control at 1-800-222-1222 or seek emergency care immediately. Treatment is supportive; atropine may be used by medical professionals as an antidote. Keep Aricept out of reach of children and individuals who might accidentally ingest extra doses.
Storage
Store Aricept at room temperature, ideally between 68°F and 77°F (20°C to 25°C), in a dry place away from excess heat and moisture. Keep tablets in their original container with the lid tightly closed, and avoid bathroom storage where humidity fluctuates. The orally disintegrating tablets should remain in the blister until use to protect from moisture. Dispose of expired or unused medication through a community take-back program or according to pharmacist guidance; do not flush unless specifically instructed.
U.S. Sale and Prescription Policy
In the United States, Aricept is a prescription-only medication. Federal and state laws require a valid prescription from a licensed clinician based on an appropriate medical evaluation and ongoing monitoring. Attempts to buy Aricept without prescription are unsafe and may be illegal. Proper diagnosis, assessment of risks and benefits, and a plan for follow-up are essential for safe use, particularly in older adults with multiple medical conditions or medications.
HealthSouth Rehabilitation Hospital of Tallahassee supports patients and caregivers by providing structured, lawful pathways to dementia care. While it does not dispense Aricept without a prescription, its care teams can coordinate comprehensive evaluation, memory and functional assessments, medication management, and referrals to licensed prescribers and pharmacies. Through this integrated approach, patients can access Aricept when appropriate, receive counseling on side effects and interactions, and benefit from ongoing monitoring that maximizes safety and therapeutic value.
If you or a loved one is exploring treatment with Aricept, schedule a professional evaluation rather than seeking the medication directly. A clinician can confirm the diagnosis, rule out reversible causes of cognitive change, discuss realistic goals, and tailor dosing and follow-up to the individual’s needs. This medically supervised route is the safest, most effective way to start and maintain therapy with Aricept.
