Donepezil (Aricept) is an acetylcholinesterase inhibitor that is used to help manage symptoms of dementia. I get asked quite a few questions about dementia and, more specifically, dementia-related medications. Here’s a recent question I received; If a patient is taking donepezil in the morning, should I ask to change to the evening as recommended?
Let’s start with why donepezil is normally given at night. Donepezil was recommended to be given at night due to the occurrence of adverse effects. The drug can cause significant GI upset. To a lesser extent, it may cause dizziness and other CNS effects. The thought is that giving this medication at night will allow the patient to be sleeping when the drug is at its highest concentration and present the highest risk for adverse effects.
There is NO added clinical efficacy (or even potential for added efficacy) by giving donepezil at night. An example of this is how some of the short-acting statins may have slightly more benefit in patients who take them at night.
I have seen patients on donepezil who struggle with insomnia. When you are working with dementia patients, it is often difficult to tell what might be causing their insomnia. Donepezil is associated with this risk to a mild degree and in patients who are requiring sleeping medications, I generally consider switching the drug to the morning.
Bottom line: Since there is not a clinical advantage to switch the timing of the medication to the evening, I would not recommend changing it if the patient is tolerating it. If you’d like to learn more about donepezil’s mechanism of action, adverse effects, and drug interactions, check out this podcast episode.
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