4.16 Acetylcholinesterase Inhibitors

Donepezil is an example of a cholinergic and acetylcholinesterase inhibitor. Acetylcholinesterase inhibitors are a class of medications that inhibit the activity of the enzyme acetylcholinesterase. This enzyme is responsible for breaking down the neurotransmitter acetylcholine. When acetylcholinesterase is inhibited, the concentration of acetylcholine at the synaptic cleft between nerve cells increases, improving nerve transmissions between cells.

Mechanism of Action: Anticholinesterase breaks down the neurotransmitter acetylcholine. Acetylcholinesterase inhibitors block this action, increasing the availability of acetylcholine.

Indications: Donepezil is an acetylcholinesterase inhibitor used for the treatment of cognitive symptoms associated with Alzheimer’s disease.

Nursing Considerations: When administering donepezil, nurses should be sure to administer with food in order to minimize GI upset. Donepezil should be taken in the evening, just prior to retiring. Donepezil may increase liver enzyme levels.

Side Effects/Adverse Effects: Common side effects of donepezil include GI upset, headaches, dizziness, insomnia, fatigue, muscle cramps, reduced quality of sleep, and nightmares.

Health Teaching & Health Promotion: Depending on the severity of cognitive impairment, clients may require assistance to ensure the medication is taken every evening. If clients miss a dose, the dose should be taken as soon as possible unless it is close to the next dose time. If it is close to the next dose period, the individual should skip the additional dose. Clients should be instructed to take the medication with food to minimize GI upset.

Now let’s take a closer look at the medication grid on donepezil in Table 4.16.^[1]

Table 4.16 Donepezil Grid