Donepezil

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jan 25, 2024

Warnings

Donepezil (Aricept) Risks, Warnings, and Complications

Donepezil can cause serious side effects and health complications in certain people. Talk to your doctor or pharmacist about other treatment options for dementia if you are at high risk of complications from this drug. Some of the risks of taking donepezil include:

ANESTHESIA: Donepezil can affect muscle relaxation during anesthesia. Tell your healthcare providers you are on this medication before any surgical procedure.
BRADYCARDIA: Donepezil can cause bradycardia (slow heartbeat), which can lead to fainting. Taking the medicine before bedtime can help prevent lightheadedness and falls. Tell your doctor if you experience dizziness on donepezil - they may reduce the dose.
NAUSEA AND VOMITING: Nausea and vomiting are common side effects of donepezil and are more frequent with higher doses. These side effects tend to occur when treatment is first initiated and after the dose is increased. Tell your doctor if nausea and vomiting continue after you have been on donepezil for 2-3 weeks.
PEPTIC ULCERS AND STOMACH BLEEDING: Donepezil can lead to increased stomach acid secretion, which can cause ulcers and stomach bleeds. The risk is higher in people with a history of stomach ulcers and those taking nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen). Tell your doctor without delay if you develop new or worsening heartburn or stomach pain while on this drug.
WEIGHT LOSS: Donepezil can cause appetite suppression and weight loss. Evidence suggests this is more likely to occur with the 23 mg dose. Before starting treatment, tell your doctor if you weigh under 55 kg (120 lbs). Talk to your healthcare provider if weight loss is a concern for you.
OTHER HEALTH CONDITIONS: Donepezil and other cholinesterase inhibitors can cause bladder outflow obstruction and seizures. These medications should be prescribed with caution to people with asthma and chronic obstructive pulmonary disease (COPD) due to their effects on respiratory muscles.
NEUROLEPTIC MALIGNANT SYNDROME: This is a serious complication of donepezil use. Seek emergency medical attention if you develop high fever, altered consciousness, irregular heartbeat, shortness of breath, sweating, or urinary incontinence.

Precautions Before Starting Donepezil (Aricept)

Tell your doctor if you have ever had an allergic reaction to donepezil, any of the active or inactive ingredients in donepezil formulations, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Donepezil may not be safe for people with certain medical conditions, such as stomach or intestinal ulcers, gastrointestinal bleeding, irregular, fast, or slow heartbeat, seizures, urinary problems, asthma, COPD, heart disease, liver disease, or kidney disease.

Tell your doctor if you are pregnant, could be pregnant, are planning a pregnancy, or are breast-feeding.

Precautions During Use of Donepezil (Aricept)

Keep all your doctor’s appointments while taking donepezil. Your doctor may adjust the dose of the medication after a few weeks.

Call your doctor if you become pregnant while on this medicine.

Tell all your doctors you are on donepezil before any surgery, including dental procedures.

Donepezil (Aricept) Drug Interactions

Certain other drugs can affect how donepezil works. Possible interactions between donepezil and other medicines can increase the risk of serious side effects. The following medications can have interactions with donepezil:

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
Antihistamines
Medications prescribed for urinary problems, such as bethanechol (Duvoid, Urecholine)
Anti-seizure drugs such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), and phenytoin (Dilantin)
Steroid medications such as dexamethasone (Decadron, Dexone)
Medications prescribed for lung diseases, such as ipratropium (Atrovent)
Antifungal agents such as ketoconazole (Nizoral)
Medications used to treat motion sickness, urinary problems, ulcers, irritable bowel disease, glaucoma, Parkinson's disease, and myasthenia gravis
Medications used to treat irregular heartbeats, such as quinidine (Quinidex)
Anti-tubercular agents such as rifampin (Rifadin, Rimactane)

The above list may not describe all possible interactions of donepezil. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC medications, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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