Contraindications and Precautions for Donepezil Use

Special Considerations

The Mayo Clinic suggests that donepezil should be used with caution in advanced dementia, as cholinesterase inhibitors may lack long-term benefit in this population, and adverse effects may outweigh benefits 1
According to the American Academy of Family Physicians, gastrointestinal effects such as nausea, vomiting, and diarrhea are more common with higher doses of donepezil, and initial increase in agitation typically subsides after a few weeks 2
The American Academy of Family Physicians recommends considering starting at a lower dose (5 mg) if the patient has a history of GI sensitivity, and to monitor for adverse effects, particularly during initiation and dose increases, with special attention to gastrointestinal symptoms and behavioral changes 2

The Mayo Clinic advises evaluating for relative contraindications, including advanced dementia, where benefits may not outweigh risks 1
The American Academy of Family Physicians suggests considering potential interactions with other medications, such as cimetidine, theophylline, warfarin, and digoxin, when prescribing donepezil 2