7 Donepezil Interactions You Should Know About

If you’re affected by Alzheimer’s disease, you might be familiar with donepezil. It’s a first-choice option for managing symptoms of Alzheimer’s-related dementia. 

Donepezil comes in a tablet version, called Aricept. It’s available as a brand-name medication and a lower-cost generic equivalent. The other version of donepezil, Adlarity, is a brand-name patch that’s expected to be available in the U.S. come fall 2022. 

If donepezil is a familiar part of your routine, other medications might be too. Adults who take donepezil often take other medications as well. And checking for possible medication interactions is very important. 

7 donepezil interactions to know about

If you or a loved one take donepezil, maximizing the benefits of the medication is likely a main goal. But another important aspect is making sure you use the medication safely. This often includes preventing and managing potential medication interactions. 

We’ll discuss a few of the top interactions with donepezil below, but know that this list doesn’t include everything. You should always review your complete medication list with a pharmacist or other healthcare provider to double check for others.

1. Anticholinergic medications

The way donepezil works is a key reason it has interactions. It raises the levels of a chemical messenger in the brain called acetylcholine. But another group of medications — called anticholinergic medications — do the opposite. They block acetylcholine from working.

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Taking both types of medications together can affect how well each of them works. That’s because they’re trying to do the opposite of the other. The following table includes common medications that may have this issue:

When possible, it’s ideal to avoid combining these medications. But depending on other health conditions you may have, this isn’t always possible. Your healthcare provider can talk to you about using these medications safely and how to watch for side effects.

2. Other cholinergic medications

Medications like bethanechol and pilocarpine (Salagen) work in a similar way to donepezil. They also affect acetylcholine. They mimic acetylcholine and activate its receptors (chemical binding sites) in your body. Using either of them with donepezil is like doing too much of the same thing. This could worsen side effects — such as nausea, diarrhea, or headache — of either medication. 

3. Beta blockers

Beta blockers are medications that lower blood pressure and slow down heart rate. Some of the most common beta blockers are carvedilol (Coreg), metoprolol (Lopressor, Toprol XL), and propranolol. Donepezil may also slow your heart rate. 

If you take donepezil with a beta blocker, there’s a higher risk of your heart beating too slowly. The combination can also make your blood pressure lower than it should be. This could put you at risk for a fall, as it can make you pass out (faint). 

Your healthcare provider should screen for these risks before you start taking donepezil. And you can check your heart rate and speak to your provider if you have any symptoms of dizziness or fatigue.

4. Anesthesia medications like succinylcholine

Succinylcholine is a medication that relaxes your muscles. It’s usually used for anesthesia. Donepezil could amplify the effect of succinylcholine and cause too much muscle relaxation. 

If you’re going to receive anesthesia, make sure your updated medication list is on file. This will help your care team choose the most appropriate anesthesia for your procedure.

5. Certain heart rhythm medications

Donepezil can affect your heart rhythm. Specifically, it can impact a part of the heartbeat cycle called the QT interval. It may interact with other medications that also affect the QT interval. Some of these are used to treat irregular heart rhythms. Here are some examples:

• Amiodarone (Pacerone)

• Dronedarone (Multaq)

• Quinidine

• Sotalol (Betapace)

This can be a dangerous interaction that can lead to fainting. In rarer cases, serious heart complications are also possible. Your healthcare provider may make adjustments to your treatment to avoid this combination. Or they may just keep an eye on your heart rate and rhythm. 

If you feel dizzy, weak, or feel your heart beating differently than normal, be sure to contact your healthcare provider right away. 

6. Some antipsychotic medications

Certain mood regulating medications can also affect the QT interval. These include: 

• Haloperidol (Haldol)

• Thioridazine

• Quetiapine (Seroquel)

• Ziprasidone (Geodon)

Typical antipsychotics, like haloperidol, can also have other interactions with donepezil. These medications have anticholinergic properties and could interfere with how well donepezil works. Donepezil may also worsen side effects of typical antipsychotics. Let your healthcare provider know if you notice any new muscle stiffness or spasms if you are taking these medications together. In this case, your provider may make adjustments to your treatment. 

7. Some antifungal medications

The liver breaks down (metabolizes) donepezil. If other medications affect how well the liver can do this, there could be an interaction. This can change how well donepezil works or worsen the risk of side effects. 

One of these medications is ketoconazole, a type of antifungal medication. It may increase donepezil levels in the body. What effect this has isn't well known. But it's still important to be aware of this interaction and discuss it with your provider.

When should I contact my healthcare provider about a donepezil interaction?

If you’re concerned about a possible interaction, contact them right away. They can help guide you through the situation at hand. 

If you come across a mild or moderate interaction you can't avoid, you may just need to keep a close eye out for symptoms. For a more severe interaction, your healthcare provider may consider other options. It all starts with a discussion between you and your healthcare provider or pharmacist. 

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Written by:

Hindu Rao, PharmD, APh, BCACP

Hindu Rao, PharmD, APh, BCACP is a clinical assistant professor of pharmacy practice at Chapman University School of Pharmacy and a clinical pharmacist at Providence Medical Foundation. She specializes in chronic disease management and has her board certification in ambulatory care.

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:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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