Aricept: What It Is, How It Works, and Who It Helps for Alzheimer’s

Aricept is not a cure. But for millions of people living with Alzheimer’s disease, it’s one of the few tools that can slow the fade - giving families more time with their loved ones, and patients more clarity in their daily lives. Developed in the late 1990s and still widely prescribed today, Aricept (generic name: donepezil) is an acetylcholinesterase inhibitor. That means it works by keeping a brain chemical called acetylcholine active for longer. In Alzheimer’s, brain cells that make acetylcholine die off. This chemical is critical for memory, thinking, and learning. When levels drop, symptoms get worse. Aricept doesn’t bring back dead cells. But it helps the ones still working do their job better.

How Aricept Actually Works in the Brain

Think of your brain like a crowded room where people are passing notes. Acetylcholine is the note. In a healthy brain, notes get passed smoothly between neurons. In Alzheimer’s, the people passing notes start disappearing. Even worse, the ones left behind are too tired to keep going. Aricept doesn’t bring back the missing people. But it stops others from wiping the notes too soon. It blocks the enzyme - acetylcholinesterase - that breaks down acetylcholine. So the notes stick around longer. That gives the brain a bit more time to process thoughts, recall names, or remember where you put your keys.

It’s not magic. You won’t suddenly remember your grandchild’s birthday if you couldn’t before. But many people report small wins: remembering to take their pills, recognizing a familiar face, or staying focused during a conversation a little longer. In clinical trials, about 30% to 40% of patients on Aricept showed measurable improvement in daily function compared to those on placebo. That might sound low, but for families watching a loved one slip away, even small gains matter.

Who Gets Prescribed Aricept?

Aricept is approved for mild, moderate, and severe Alzheimer’s disease. That’s unusual. Most drugs only work in early stages. But Aricept has been shown to help across the spectrum. Doctors often start it when someone begins showing clear signs of memory loss that interfere with daily life - forgetting appointments, repeating questions, getting lost in familiar places. It’s not for normal aging. If your mom forgets where she put her glasses, that’s normal. If she forgets what glasses are for, that’s a red flag.

It’s also not used for other types of dementia like vascular dementia or Lewy body dementia - unless Alzheimer’s is the main driver. Some doctors will try it off-label for mild cognitive impairment (MCI), especially if brain scans show early Alzheimer’s changes. But there’s no strong proof it stops MCI from turning into full Alzheimer’s. So most guidelines don’t recommend it for that alone.

Dosing and How to Take It

Aricept comes in tablets: 5 mg, 10 mg, and 23 mg. Most people start at 5 mg once a day, taken at night before bed. Why at night? Because the most common side effect is nausea - and sleeping through it helps. After four to six weeks, your doctor may bump you up to 10 mg. That’s the standard dose for mild to moderate cases. For severe Alzheimer’s, the 23 mg dose was approved in 2010. Studies showed it gave a small but real extra benefit in cognition and daily function compared to 10 mg - but also more side effects.

You don’t need to take it with food. But if your stomach feels upset, having a light snack helps. The tablet dissolves easily. Some people crush it and mix it with applesauce if swallowing is hard. Always check with your pharmacist first - not all meds can be crushed, but Aricept can.

Side Effects and Risks

Most people tolerate Aricept well. But about 1 in 4 will have some side effects. The most common: nausea, vomiting, diarrhea, loss of appetite, muscle cramps, and trouble sleeping. These usually fade after a few weeks. If they don’t, your doctor might lower the dose or switch you to a different medication.

Less common but more serious risks include slow heart rate (bradycardia), fainting, or stomach ulcers. People with pacemakers, heart rhythm problems, or a history of ulcers need extra monitoring. Aricept can also make asthma or COPD worse. If someone starts wheezing or feels dizzy after starting the drug, call the doctor right away.

It’s also not safe with certain other meds. Anti-inflammatory drugs like ibuprofen can increase stomach bleeding risk. Some antidepressants and antifungals can interfere with how Aricept is broken down. Always tell your doctor everything you’re taking - even herbs or supplements. Ginkgo biloba, for example, can increase the chance of bleeding when mixed with Aricept.

What Happens When You Stop Taking It?

Stopping Aricept suddenly doesn’t cause withdrawal. But the brain loses the extra acetylcholine boost. Symptoms usually start creeping back within weeks. Many families report their loved one seems to decline faster after stopping. That’s not because the drug was holding back the disease - it was just helping the brain compensate. Once that help is gone, the underlying damage shows up more clearly.

Some people stop because of side effects. Others stop because they think it’s not working. But if you don’t see big changes, that doesn’t mean it’s useless. Alzheimer’s is a slow, relentless march. Aricept’s job isn’t to stop the march - it’s to slow the steps. If your mom still recognizes you after six months on Aricept, that’s a win.

Alternatives to Aricept

There are two other acetylcholinesterase inhibitors approved for Alzheimer’s: Exelon (rivastigmine) and Namenda (memantine). Exelon comes as a patch or capsule and is often used when stomach issues make pills hard to tolerate. Namenda works differently - it blocks excess glutamate, another brain chemical that can become toxic in Alzheimer’s. It’s usually paired with Aricept in moderate to severe cases. Together, they cover two different pathways of damage.

Newer drugs like Leqembi and Aduhelm target the amyloid plaques thought to cause Alzheimer’s. But they’re given by IV infusion, cost over $25,000 a year, and carry serious brain-swelling risks. They’re only for early-stage patients with confirmed amyloid buildup. Most people on Aricept won’t qualify.

For now, Aricept remains the most widely used, safest, and most affordable option. A 30-day supply of generic donepezil costs under $15 in many countries. Brand-name Aricept is much pricier - but there’s rarely a reason to pay extra.

Real-Life Impact: What Families Notice

One woman in Durban told her doctor her husband, who had Alzheimer’s for three years, stopped recognizing her. After starting Aricept, he began calling her by name again - not every day, but enough to make her cry. Another man, 78, started forgetting how to use the TV remote. Two months on Aricept, he was watching his favorite soccer matches again. He didn’t remember the score, but he knew he was watching the game. That mattered.

These aren’t dramatic recoveries. But they’re real. They give people back small pieces of dignity. The ability to eat without help. To dress themselves. To smile at a familiar song. That’s what Aricept does. It doesn’t fix the brain. But it gives it a little more time to be itself.

When to Talk to Your Doctor

If you or someone you care for is showing signs of memory loss - especially if it’s getting worse - don’t wait. See a doctor. Don’t assume it’s just aging. Early diagnosis matters. Even if Aricept won’t stop the disease, starting it early can make a difference in quality of life.

Also, if you’re already on Aricept and notice new symptoms: confusion, fainting, chest pain, or sudden vomiting, get help. These could be signs of a reaction. And if you’re thinking about stopping the drug - talk to your doctor first. Don’t just quit.

Aricept isn’t perfect. But for now, it’s one of the most reliable tools we have. It doesn’t promise miracles. But it does offer something rare in Alzheimer’s care: a chance to hold on a little longer.