Alzime Warnings

Cholinesterase inhibitors may cause bradycardia and/or heart block with or without a history of cardiac disease; syncopal episodes have been associated with donepezil. Alzheimer's treatment guidelines consider bradycardia to be a relative contraindication for use of centrally-active cholinesterase inhibitors.
Use with caution with sick sinus syndrome or other supraventricular cardiac conduction abnormalities, COPD, or asthma.
Use with caution in patients with a history of seizure disorder; cholinomimetics may potentially cause generalized seizures, although seizure activity may also result from Alzheimer's disease.
Use with caution in patients at risk of ulcer disease (e.g., previous history or NSAID use), or in patients with bladder outlet obstruction.
May cause dose-related diarrhea, nausea, and/or vomiting, which usually resolves in 1-3 weeks.
May cause anorexia and/or weight loss (dose-related).
May exaggerate neuromuscular blockade effects of depolarizing neuromuscular-blocking agents (e.g., succinylcholine).