Donepezil's Impact on Anxiety in Dementia Patients

Initial Agitation vs. Sustained Anxiety Worsening

• The American Academy of Family Physicians notes that donepezil may cause an initial increase in agitation in some patients, but this typically subsides after a few weeks 1
• The American Academy of Family Physicians explicitly states that donepezil's initial increase in agitation should not be confused with sustained anxiety worsening, and sustained anxiety is not listed as a side effect of donepezil 2

Clinical Management of Initial Agitation

• When initiating donepezil therapy, start with 5 mg once daily in the evening to minimize side effects 3
• Take donepezil with food to reduce gastrointestinal and potentially behavioral side effects 1, 3
• Counsel patients and caregivers that any initial agitation typically resolves within the first few weeks 1
• Increase to 10 mg daily after 4-6 weeks only if the initial dose is tolerated 3

Important Caveats

• If anxiety or agitation persists beyond the first few weeks of treatment, consider other contributing factors such as disease progression, comorbid conditions, or environmental stressors rather than attributing it solely to donepezil 2