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Donepezil Dose Escalation — SCE Neurology MCQ

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EasyNeurodegenerative DiseaseDonepezil Dose EscalationSCE Neurology

A 78-year-old man with mild Alzheimer disease has completed four weeks of donepezil 5 mg nightly. His daughter reports two unexplained collapses; pulse is 44/min and ECG shows first-degree atrioventricular block. Cognition has not deteriorated. What is the most appropriate next step?

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Correct answer: D — Continue donepezil 5 mg and arrange review of the bradycardia before any dose escalation

Donepezil can produce vagotonic bradycardia, conduction block and syncope. Although a tolerated 5 mg dose can usually be increased after one month, new bradycardia and syncope require cardiovascular assessment before escalation. Beta blockade can worsen the physiology. A permanent switch to memantine is not automatically required, but increasing the cholinesterase inhibitor without investigating the collapses is unsafe.

Reference: Donepezil Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/4428/smpc