Selective reversible acetylcholinesterase inhibitor
ATC code: N06DA02 (Donepezil)
Brand names
Aricept Evess, Aricept, Donaz
A selective reversible acetylcholinesterase inhibitor in the CNS. In Alzheimer's disease, it raises synaptic acetylcholine, partly compensating cholinergic deficit. Does not affect peripheral butyrylcholinesterase, so causes fewer GI side effects than rivastigmine. CYP2D6- and CYP3A4-metabolized; half-life 70 hours – once-daily dosing.
First line
First-line drug for Alzheimer's disease across all stages per 2018, 2024, and the Spanish SEN 2024 consensus. Starting dose 5 mg once daily at bedtime; uptitrate to 10 mg after 4–6 weeks. In severe disease, a 23 mg dose is available (US) or 10 mg is continued (EU). The 2018 Cochrane meta-analysis showed cognitive improvement (ADAS-Cog) by 2.9 points and functional gains. Effect is symptomatic and does not modify progression.
Second line
In dementia with Lewy bodies and Parkinson's disease dementia, acetylcholinesterase inhibitors (donepezil, rivastigmine) are used off-label per 2024 to ease cognitive symptoms and psychotic features. Among formally approved EU options for these diagnoses, rivastigmine is more commonly registered.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Donepezil is a cholinesterase inhibitor. It is prescribed only for mild-to-moderate Alzheimer's disease ( 2018 and NG97 guidelines). In biohacker communities, donepezil is promoted as a cognitive enhancer for healthy students and knowledge workers. Clinical studies in healthy adults have not shown improvement in memory or attention. The drug carries serious risks: bradycardia, syncope, nausea, vomiting, diarrhea, weight loss, and seizures. In healthy people these risks are not justified. If donepezil was recommended for memory improvement in a healthy person, consider seeking a second opinion.
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Not indicated – Alzheimer's in women of reproductive age is exceedingly rare.
No data. Not used during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Donepezil is evaluated for the following indications with varying evidence strength: Alzheimer disease (evidence tier A), Dementia (evidence tier B), Memory and concentration enhancement (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Donepezil (≥ 1 in 100): Nausea, vomiting, diarrhea, Reduced appetite and weight loss, Insomnia and vivid dreams, Headache, Bradycardia, Muscle cramps. See the Safety section for uncommon and serious reactions.
FDA category C. Not indicated – Alzheimer's in women of reproductive age is exceedingly rare.
No data. Not used during lactation.
Donepezil is contraindicated in: Hypersensitivity to donepezil or piperidine derivatives; Pregnancy and lactation; Age under 18. Full list in the Safety section.