Clinical decision-support only. For use by licensed dental professionals. Not a substitute for professional judgment or a complete drug reference. Always verify with primary sources.
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Medication

Donepezil

Acetylcholinesterase inhibitor (anti-dementia)

Brand names: Aricept

Oral health effects

  • Hypersalivation (sialorrhea)

    By boosting cholinergic activity, cholinesterase inhibitors can increase salivation, the opposite of most CNS drugs.

    Mechanism: Increased acetylcholine stimulates salivary glands.

    Clinical management: Relevant for procedures needing a dry field; consider suction/positioning. Note dexterity/cognition may limit hygiene.

  • Slow heart rate and fainting (bradycardia/syncope)

    Cholinesterase inhibitors have vagotonic effects that can cause bradycardia or heart block (label warning); syncope was reported in about 2% vs 1% on placebo.

    Clinical management: Check pulse before treatment. Watch for fainting, particularly when the patient sits up or stands, and avoid long supine appointments; report a slow or irregular pulse to the physician.

Sources

  1. A review and guide to drug-associated oral adverse effects-Dental, salivary and neurosensory reactions. Part 1. Teoh L, Moses G, McCullough MJ. Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 2019.
  2. Donepezil prescribing information (FDA label) Lupin Pharmaceuticals, Inc. / DailyMed, 2024.