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Related Experiment Videos

Donepezil overdose: a tenfold dosing error.

G Shepherd1, W Klein-Schwartz, R Edwards

  • 1Maryland Poison Center, School of Pharmacy, University of Maryland, Baltimore, USA. gsheph@parknet.pmh.org

The Annals of Pharmacotherapy
|August 31, 1999
PubMed
Summary
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A tenfold overdose of donepezil, used for Alzheimer disease, caused significant bradycardia in a patient. Atropine treatment effectively managed the slow heart rate, highlighting the risks of medication errors.

Area of Science:

  • Pharmacology
  • Geriatric Medicine
  • Patient Safety

Background:

  • Donepezil is a key treatment for Alzheimer disease, acting as a cholinesterase inhibitor.
  • Its high specificity for neural targets minimizes peripheral side effects at therapeutic doses.

Observation:

  • A 79-year-old patient received a tenfold overdose of donepezil (50 mg instead of 5 mg).
  • She presented with severe nausea, vomiting, and persistent bradycardia (heart rate in the 40s).
  • Pulmonary findings (basilar rales) were noted hours after presentation.

Findings:

  • The patient's bradycardia was treated with atropine, with temporary heart rate increases after each dose.
  • No further vomiting or pulmonary edema occurred after initial treatment.
  • The patient recovered to baseline heart rate within two days.

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Implications:

  • Medication errors, such as accidental overdoses, are a significant cause of morbidity in healthcare settings.
  • This case underscores the importance of careful medication management to prevent adverse events.
  • Accurate dosing is critical for donepezil to maintain efficacy while minimizing toxicity.