DONEPEZIL HCL (donepezil hcl)

There are 0 contraindications.

There are 12 severe contraindications. Adequate patient monitoring is recommended for safer drug use.

Severe List
Acute decompensated heart failure
Acute myocardial infarction
Atrioventricular block
Congenital long QT syndrome
Gastrointestinal hemorrhage
Gastrointestinal ulcer
Neuroleptic malignant syndrome
Prolonged QT interval
Rhabdomyolysis
Sick sinus syndrome
Sinus bradycardia
Torsades de pointes

There are 7 moderate contraindications. Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.

Moderate List
30 day risk period post-myocardial infarction
Asthma
Bladder outflow obstruction
Chronic obstructive pulmonary disease
Hypokalemia
Hypomagnesemia
Seizure disorder

There are 40 severe adverse reactions.

More Frequent	Less Frequent
Diarrhea	Anorexia Arthritis Dizziness Fatigue Increased urinary frequency Syncope

Rare/Very Rare

Abdominal pain with cramps Aggressive behavior Anemia Aphasia Ataxia Atrial fibrillation Blurred vision Bradycardia Cataracts Chest pain Dehydration Delusional disorder DRESS syndrome Dyspnea Fecal incontinence Flatulence Gastrointestinal hemorrhage Heart block Heart failure Hyperhidrosis Hypertension Hypotension Nervousness Neuroleptic malignant syndrome Paresthesia Peripheral edema Prolonged QT interval Rhabdomyolysis Seizure disorder Stevens-johnson syndrome Torsades de pointes Toxic epidermal necrolysis Urticaria

There are 26 less severe adverse reactions.

More Frequent	Less Frequent
Cramps Insomnia Nausea Vomiting	Depression Drowsy Ecchymosis Headache disorder Nightmares Pain Weight loss

Rare/Very Rare
Abnormal hepatic function tests Altered mental status Bronchitis Drug-induced hot flash Genitourinary tract infections Irritability Libido changes Mood changes Nocturia Ocular irritation Pruritus of skin Tremor Urinary incontinence Vasodilation of blood vessels Vertigo

There are no adequate data to inform the developmental risks associated with the use of donepezil in pregnant women. Animal reproduction studies did not demonstrate any evidence of developmental toxicity when the drug was administered to pregnant rats and rabbits during the period of organogenesis; however, when the drug was administered at clinically relevant doses during later stages of pregnancy and throughout lactation, increased stillbirths and decreased offspring survival were observed.

It is not known whether donepezil is distributed into human milk or if the drug has any effects on nursing infants or milk production. The known benefits of breast-feeding should be considered along with the mother's need for the drug and any potential adverse effects on the breast-fed infant from the drug or underlying maternal condition.

Precaution Exists
Precaution exists. (No data or inconclusive human data.) Use of this drug by breast feeding mothers should be evaluated carefully.

Drug Name	Excretion Potential	Effect on Infant	Notes
Donepezil	Unknown. It is unknown whether the drug is excreted in human breast milk.	It is not known whether this drug has an adverse effect on the nursing infant. (No data or inconclusive human data)	Insufficient human data available

Population pharmacokinetic analysis indicates that clearance of donepezil decreases with increasing age. Compared with patients who were 65 years of age, clearance of donepezil was decreased by 17% in patients 90 years of age and increased by 33% in patients 40 years of age; however, the manufacturer states that these changes may not be clinically important.

Precaution Exists
Geriatric management or monitoring precaution exists.

Drug Name	Narrative	REN	HEP	CARDIO	NEURO	PULM	ENDO
Donepezil	General-Recent rare reports of rhabdomyolysis and NMS. Cardiovascular-Cholinesterase inhibitors can have vagotonic effects on the SA & AV nodes resulting in bradycardia or AV block. Urogenital-May cause bladder outflow obstruction in those patients who are predisposed. Gastrointestinal-Use with caution in patients with history of or active PUD or GI bleeding. Dose dependent N/V, diarrhea.	N	N	Y	N	N	N