May increase the neurotoxic effect of antipsychotics. Concurrent use with systemic corticosteroids may increase the adverse effects of donepezil May increase the neuromuscular blocking effect of succinyl choline. May increase the advese effects of cholinergic agonists. May increase the bradycardic effect of betablockers

Nausea, vomting, anorexia, Weight loss, insomnia, fatigue, Muscle cramps, headache, dizziness, Syncope, bradycardia, Convulsions, Increased liver transaminase, sinoatrial and atrioventricular block, Hallucinations, agitation, aggressive behaviour Minor increases in plasma creatinine kinase, Potentially bladder outflow obstruction

Hypersensitivity Special precautions-

Caution when used in patients with sick sinus syndrome or cardiac conduction abnormalities May increae secretion of gastric acid.

Caution when used in patients at risk of ulcer disease Patients with COPD asthma History of epilepsy, bladder obstruction, prostrate hypertrophy May cause dose related diarrhoea, nausea, and or vomiting which usually resolves after 1-3 weeks Safety and efficacy not established in children Pregnancy Lactation

Adult- initially 5mg at bedtime, increase if necessary up to 10mg once daily at bed time. after 4-6 weeks

Elderly- initially 5mg daily at bed time, increase if necessary up to 10mg once daily at bed time after 4-6 weeks

Special Precautions-                                                                                                       

 Patients with history of asthma,or COPD, sick sinus syndrome, suprventrucular abnormalities, GI or urinary tract infections, Hepatic impairment

Patient Councelling-                                                                                                            May impair ability ability to drive or operate machinery . Monitor mental status or GI intorence or bleeding

Contraindicated for use during pregnancy and lactation Observe caution if required to be used during this period