Donepezil and other cholinomimetic agents have the potential to trigger seizures. Therefore, clinicians should be cautious when prescribing it to patients with a history of seizure disorder.
Cholinomimetic agents, including donepezil, have the potential to cause or exacerbate bladder outflow obstruction. Therefore, caution is necessary when prescribing these medications to patients with a history of prostatic hyperplasia.
Cholinesterase inhibitors, including donepezil, can lead to increased gastric acid secretion. Hence, caution should be exercised when prescribing these medications to patients at risk of ulcer disease. In addition, monitoring for symptoms of GI bleeding is essential.[26]
Donepezil can potentiate muscle relaxation induced by succinylcholine during anesthesia.[27]
Donepezil should be prescribed cautiously to patients with a history of asthma or obstructive pulmonary disease because of its cholinomimetic properties.[28]
Donepezil should be used with caution in patients at risk for rhabdomyolysis. Risk factors include a history of muscular disorders, uncontrolled hypothyroidism, and concomitant use of medications associated with rhabdomyolysis.[29]