Donepezil: A review of pharmacological characteristics and role in the management of Alzheimer disease

We reviewed the literature on the pharmacological characteristics and role of donepezil in Alzheimer disease. We performed an evidence-based review of randomized controlled trials by searching sources such as PubMed, MEDLINE, Google Scholar, and Clinical Key. In total, 18 randomized clinical trials were identified. In amnestic mild cognitive impairment (MCI), data showed that donepezil delays progression to Alzheimer disease. However, for mild-to-moderate and moderate-to-severe Alzheimer disease, it proved effective in slowing cognitive and global function decline. Discontinuation of donepezil results in acceleration of disease progression. The effects of donepezil on behavioral symptoms have shown mixed outcomes. Donepezil is the standard of care in Alzheimer disease as it is well tolerated and has self-limiting gastrointestinal adverse effects. In amnestic MCI, off-label use of donepezil can be considered after risk stratification of conversion to Alzheimer disease.