A 10-year perspective on donepezil

Introduction: Donepezil is the first cholinesterase inhibitor widely used for the treatment of Alzheimer's disease (AD). Its pharmacological actions are straightforward, enhancing cholinergic activity both in the brain and systemically, with a long-enough half-life to allow for once a day dosing. Its efficacy has been approved for use in mild-to-moderate AD stage for improvement of symptoms for 10 years, and now it is also approved for use in severe stage. Areas covered: This review article will offer a 10-year perspective on the use of donepezil in clinical practice against AD and related disorders. In addition to discussing the information from randomized clinical trials and from the drug monograph, this article will seek to facilitate the clinical development and clinical use of the next generation of drugs for AD. Expert opinion: Adjustments about expectations and safe use of donepezil were made over time based on such clinical experiences. Offering a cholinesterase inhibitor to patients with mild-to-moderate AD clearly showed advantages. If well tolerated, donepezil should be continued in the severe stages of AD as long as the patient appears to benefit from a slower clinical decline.