Although occurrence of seizures is rare, people who have a predisposition to seizures should be treated with caution.If daily donepezil has suspended for 7 days or less, restarting at the same dose is recommended, while if the suspension lasts longer than 7 days, retitrate from 5 mg daily is suggested. Mechanism of action
Donepezil binds and reversibly inactivates the cholinesterases, thus inhibiting hydrolysis of acetylcholine. This increases acetylcholine concentrations at cholinergic synapses.The precise mechanism of action of donepezil in patients with Alzheimers disease is not fully understood. Certainly, Alzheimers disease involves a substantial loss of the elements of the cholinergic system and it is generally accepted that the symptoms of Alzheimers disease are related to this cholinergic deficit, particularly in the cerebral cortex and other areas of the brain.In addition to its actions as an acetylcholinesterase inhibitor, donepezil has been found to act as a potent agonist of the σ1 receptor (Ki = 14.6 nM), and has been shown to produce specific antiamnestic effects in animals mainly via this action.Some noncholinergic mechanisms have also been proposed. Donepezil upregulates the nicotinic receptors in the cortical neurons, adding to neuroprotective property. It inhibits voltage-activated sodium currents reversibly and delays rectifier potassium currents and fast transient potassium currents, although this action is unlikely to contribute to clinical effects. Synergy
Donepezil was claimed to act synergistically with an agent called FK962 [283167-06-6] & FK960 [133920-70-4]. {potential activation of somatostatinergic neurotransmission}

Stereochemistry
Donepezil medications are racemates.
heartburn of unknown origin) acupuncture may be as effective if not more than PPIs alone. Surgical management
In the case of GERD causing heartburn symptoms, surgery may be required if PPI is not effective. Surgery is not undergone if functional heartburn is the leading diagnosis. Epidemiology
About 42% of the United States population has had heartburn at some point. == References ==