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Donepezil hydrochloride, a piperidine derivative, is a centrally acting, rapid, and reversible acetylcholinesterase inhibitor primarily utilized for treating Alzheimer disease. Acetylcholinesterase is an enzyme that breaks down acetylcholine after its release from the presynapse. By binding reversibly to acetylcholinesterase, donepezil inhibits acetylcholine hydrolysis, thereby increasing acetylcholine availability at the synapses and enhancing cholinergic transmission. The U.S. Food and Drug Administration (FDA) approved the drug for the treatment of dementia in mild, moderate, and severe Alzheimer disease. Although there is currently no evidence to suggest that donepezil can alter the progression of the disease, it has shown efficacy in alleviating specific symptoms by improving cognition and/or behavior in affected individuals. In addition to its FDA-approved use in Alzheimer disease, donepezil has various off-label indications. This activity emphasizes the mechanism of action, adverse event profile, pharmacokinetics, monitoring requirements, and relevant drug interactions of donepezil. This information is crucial for interprofessional team members involved in treating patients with dementia associated with Alzheimer disease. Objectives: Identify appropriate candidates for donepezil therapy based on clinical criteria and diagnostic guidelines for Alzheimer disease. Screen patients for potential contraindications, comorbidities, or risk factors associated with donepezil, which may influence the use of the drug in Alzheimer treatment. Assess the treatment efficacy and tolerability of donepezil in patients with Alzheimer disease through regular cognitive and behavioral evaluations. Coordinate ongoing monitoring and follow-up care among healthcare professionals, caregivers, and support systems to address the potential issues and complex needs of patients receiving donepezil for Alzheimer disease management. Access free multiple choice questions on this topic.

General supportive measures are crucial for a donepezil overdose, and the clinician should immediately contact the poison control center. An overdose of donepezil can trigger a cholinergic crisis, leading to severe symptoms like nausea, vomiting, excessive sweating, and salivation. Furthermore, bradycardia, hypotension, respiratory depression, collapse, and seizures are potential manifestations of an overdose.[34] An overdose of donepezil can lead to increased muscle weakness and may even result in death in severe cases involving respiratory muscles. Some reported cases of overdose have also shown hepatotoxicity. As with other anticholinesterase inhibitor toxicities, tertiary anticholinergics, such as atropine, may be used as an antidote for donepezil overdose. The intravenous atropine dose should be titrated based on the patient's clinical response. Currently, the information on whether donepezil or its metabolites can be removed through hemodialysis, peritoneal dialysis, or hemofiltration is unknown.[35][36] Clinicians should be aware that the clinical presentation of donepezil toxicity can resemble a beta-blocker overdose. Therefore, it is crucial to reassess the diagnosis if the patient does not respond as expected to standard therapy.[37]

Donepezil is primarily used for the treatment of dementia associated with Alzheimer disease and has FDA approval for use in mild, moderate, and severe stages of the disease. Educating the family and caregivers about the fact that donepezil does not alter the progression of Alzheimer disease is vital to establish realistic expectations for this treatment. However, donepezil can temporarily alleviate some symptoms by improving cognition and behavior. Healthcare professionals, including clinicians, must be aware of the benefits and limitations of donepezil when prescribing the drug to older adults. After initiating treatment, physicians should conduct regular follow-ups for cognition and behavior assessments to evaluate the effectiveness of the medication and check for drug tolerance. In addition, monitoring for any symptoms of cholinergic excess is essential during treatment. A pharmacist consultation should include verifying the dosing, reconciling medication, and checking for potential drug-drug interactions. If any issues arise, the pharmacist should promptly report them to the prescriber. On the other hand, nurses should diligently monitor for adverse effects, assess medication compliance, and evaluate the therapeutic effectiveness of the treatment. Interprofessional team members need to collaborate and work together and set clear patient, family, and caregiver expectations regarding the expected outcomes of donepezil and other pharmaceutical therapies used to treat Alzheimer disease. Consulting with neurologists is of utmost importance for the treatment of severe Alzheimer disease. The management of dementia necessitates an interprofessional team approach involving healthcare professionals such as physicians, advanced practice practitioners, specialists, nursing staff, and pharmacists, as well as the involvement of family and caregivers. Collaborative decision-making and open communication among all team members are essential in driving optimal patient outcomes.[1][2] Research highlights the significance of an interprofessional team approach, particularly the collaboration between advanced practice practitioners and physicians, working with the patient's family caregiver to achieve optimal outcomes in primary care settings.[38]