Bruera, E., Strasser, F., Shen, L., Palmer, J.L., Willey, J., Driver, L.C., & Burton, A.W. (2003). The effect of donepezil on sedation and other symptoms in patients receiving opioids for cancer pain: A pilot study. Journal of Pain and Symptom Management, 26, 1049–1054.

Donepezil 5 mg every morning for seven days

• N = 27
• MEDIAN AGE = 52 years (range: 24–75 years)
• FEMALES: 67%
• KEY DISEASE CHARACTERISTICS: Mixed cancer diagnoses, including hematologic, gastrointestinal, lung, head and neck, and breast
• OTHER KEY SAMPLE CHARACTERISTICS: Median oral morphine-equivalent daily dose was 180 mg per day (range: 30–600)

• SETTING TYPE: Mixed inpatient and outpatient
• LOCATION: Academic cancer center

• PHASE OF CARE: Unclear

• Open label, prospective, non-randomized pilot study 
• No comparison/control group

• Edmonton Symptom Assessment Scale (ESAS)
• Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue)

Fatigue significantly was improved following a seven-day course of treatment with donepezil. Significant improvement was noted in anxiety, well-being, sleep problems, depression, and anorexia. Pain level was unchanged. Of the initial 27 patients enrolled in the study, 7 patients were discontinued from the study due to cellulitis (1 patient), concern about a possible drug-drug interaction (1 patient), transient arterial hypertension (1 patient), increasing muscle cramps (1 patient), and mild to moderate nausea (3 patients).

• Open-label trial without a comparison group
• Small sample size
• Short length of treatment and minimal follow-up to examine longer-term side effect profile