Donepezil Dosages: Your GoodRx Guide

Alzheimer's disease causes symptoms such as forgetfulness, mood changes, and confusion. Although it’s common to have occasional memory lapses as you grow older, Alzheimer’s is not a normal part of the aging process.

Many prescription medications treat Alzheimer’s disease. Donepezil (Aricept, Adlarity) is one of them. It can be one important tool in combating symptoms of memory loss and your ability to complete daily tasks, such as cooking, shopping, and dressing yourself. It helps brain cells communicate with each other by making a neurotransmitter (brain chemical) called acetylcholine more abundant.

Donepezil comes in many forms, including an oral tablet, orally disintegrating tablet (ODT), and patch. One form isn’t better than another, but it’s good to have options based on your needs and preferences. Recommended donepezil dosages depend on many factors, including the severity of dementia symptoms and how well you’re able to tolerate the medication.

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What’s the typical donepezil dosage for adults?

Donepezil is a go-to medication for treating Alzheimer’s-related dementia. Neurologists tend to prescribe your dose based on symptom severity and side effect tolerance. There isn’t a best dose for everyone, but there is a right dose for you.

Oral donepezil

Oral donepezil, also known as Aricept, is sold as a standard tablet and an ODT. Both versions come in 5 mg and 10 mg doses, while the standard tablet is also available at a higher 23 mg dose.

Neurologists typically recommend starting off with 5 mg by mouth once daily, usually before bed. After 4 to 6 weeks of taking the 5 mg dose, your dose may go up to 10 mg if you’re tolerating the medication well.

In some cases, your neurologist may recommend taking a larger 23 mg dose if your symptoms are more severe. This dose may work better for your symptoms than a 10 mg dose. You may be eligible for this dose after taking 10 mg daily for at least 3 months.

Tip: Donepezil ODTs melt on your tongue. This makes it easier to take donepezil if you have trouble swallowing pills. Drink a glass of water after donepezil ODT dissolves.

Topical donepezil

A topical form of donepezil, called Adlarity, is available as a patch you can apply directly to your skin. It’s applied once every 7 days and slowly releases medication over time. It replaces the need to take oral donepezil every day. Donepezil patches are especially useful if you’re having difficulty swallowing or are experiencing side effects that are affecting your digestive system. 

If you opt for the patch over the pill, your neurologist will likely recommend starting with the 5 mg dose, especially if you’re new to donepezil. They may suggest increasing your donepezil patch dose to 10 mg after 4 to 6 weeks of applying the 5 mg patch. You can also switch to a 10 mg patch after taking donepezil 5 mg tablets for 4 to 6 weeks (or donepezil 10 mg tablets for any duration of time).

Donepezil patches can be applied to your back, upper outer thigh, or buttocks. Try to rotate where you apply the patch each week to prevent skin irritation. You should also avoid applying it directly on your spine.

Good to know: The 23 mg dose of donepezil is only available as an oral tablet. Your neurologist may recommend switching from a patch back to oral tablets if you need a larger donepezil dose.

Are there any dosage adjustments for medical conditions?

In some cases, yes. Your neurologist may recommend adjustments to your donepezil dose depending on your health background. This is because donepezil may aggravate some medical conditions.

EXPERT PICKS: WHAT TO READ NEXT

• Cholinesterase inhibitor overview: Get the inside scoop on how donepezil works to treat Alzheimer’s disease.

• Recognizing risks: Read on for donepezil side effects to watch out for and how to manage them.

• Managing drug interactions: Learn about important donepezil interactions with other medications you may be taking.

Heart problems

Donepezil can negatively affect people with heart conditions, such as an abnormal heartbeat (arrhythmia) or slowed heart rate (bradycardia). It can increase the risk of fainting, which is a rare side effect that some people experience while taking donepezil.

If you have a heart condition, your neurologist may be cautious with your donepezil prescription. They may stick to lower doses or recommend extra heart monitoring.

A history of bleeding

Tell your neurologist if you recall experiencing any gastrointestinal bleeds or stomach ulcers in the past. If so, they’ll likely want to use caution when first prescribing donepezil and after increasing your dose. That’s because donepezil can increase the amount of acid your stomach makes, which can worsen ulcers or cause bleeds.

Bleeding is a rare side effect of donepezil. But you should still watch out for signs of a stomach bleed, such as black, tarry stools and vomiting blood. Weakness and pale skin are also potential symptoms.

What happens if you miss a dose of donepezil?

Missing one or two doses of donepezil isn’t usually a big problem. But it’s helpful to know what to do if it happens.

It’s possible that your neurologist directed you to take donepezil at bedtime. If you realize in the morning that you forgot to take donepezil the night before, you should skip that donepezil dose. Continue with your next scheduled doses like normal. And don’t take two doses at once to make up for a missed dose. This can increase the risk of donepezil side effects such as nausea, diarrhea, and vomiting.

Consistently missed doses are the bigger issue. Talk to your neurologist if you haven’t taken or applied donepezil for 7 days. They’ll likely want to restart your donepezil prescription at a lower dose.

What should you do if you take too much donepezil?

Accidentally taking an extra dose of donepezil may result in uncomfortable side effects. These should go away with time, but make sure to contact your prescriber if you have any concerns. You can also contact Poison Control online or by calling 1-800-222-1222.

A larger donepezil overdose can lead to more serious side effects. It can lead to a medical condition known as cholinergic crisis. Call 911 or go to the nearest ER if you’re having any symptoms like these:

• Intense nausea or vomiting

• Producing a lot of saliva

• Unexplained sweating

• Slow heart rate

• Low blood pressure (hypotension)

• Slow or shallow breathing (respiratory depression)

• Seizures

• Muscle paralysis

How to save on donepezil

There are ways to save on oral and topical donepezil. Both are available as brand-name medications. But you can also find oral donepezil as a lower-cost generic. GoodRx can help you navigate ways to save on your prescription.

• Save with GoodRx: A month’s supply of generic donepezil tablets costs as little as $9.00 at certain pharmacies with a free GoodRx discount. The generic ODT version is as low as $19.08, and brand-name Adlarity is as low as $450.74. 

• Save with a copay savings card: If you have commercial insurance and meet eligibility requirements, Adlarity’s price is no more than $30 per prescription using a savings card from the manufacturer.

• Save with patient assistance programs: If you’re uninsured or underinsured, you may be eligible for Aricept’s patient assistance program, which offers the medication free of cost.

Why trust our experts?

Written by:

Mandeep Sohal, PharmD

Mandeep Sohal, PharmD, has more than 7 years of experience in the pharmaceutical industry and is licensed in California. In his career, he’s had experience with specialty pharmacy, community pharmacy, pharmacy benefit management, and pharmaceutical manufacturers.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

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