Exelon vs Donepezil: Which Dementia Drug Works Better?

When it comes to treating Alzheimer’s disease, Exelon, a brand name for rivastigmine, is a cholinesterase inhibitor used to slow cognitive decline in mild to moderate Alzheimer’s and Parkinson’s dementia. Also known as rivastigmine, it works by boosting acetylcholine levels in the brain—something that drops as the disease progresses. Donepezil, sold as Aricept, is another cholinesterase inhibitor approved for all stages of Alzheimer’s, from mild to severe. Also known as Aricept, it’s often the first drug doctors prescribe because of its once-daily dosing and broad approval range. Both drugs aim to help with memory, thinking, and daily function—but they’re not the same.

Exelon comes as a patch or oral solution, which helps people who have trouble swallowing pills. That’s a big deal if nausea or vomiting is an issue—common side effects with these meds. Donepezil is usually a pill taken at night, which some find easier to stick with. But it’s more likely to cause insomnia or muscle cramps. Studies show both drugs offer similar cognitive benefits over time, but Exelon’s patch form might lead to fewer stomach problems. Donepezil, on the other hand, tends to have a longer half-life, meaning it stays active longer in the body, which can mean more consistent effects.

Neither drug stops Alzheimer’s. Neither reverses damage. But they can help people hold onto independence a little longer—whether that’s remembering a name, managing meds, or staying oriented during the day. If someone’s already on one and doing okay, switching isn’t always worth the risk. But if side effects are too much, or if the drug stops working, switching between Exelon and Donepezil is a real option doctors use all the time. You’ll also find these two pop up in discussions about combination therapy, especially when paired with memantine for moderate to severe cases.

What you’ll find below is a collection of real, practical comparisons—just like Exelon vs Donepezil—between other common dementia and neurological drugs. We’ve got posts on how Rivastigmine stacks up against other cholinesterase inhibitors, how Donepezil compares to memantine, and even how these drugs interact with common painkillers or heart meds. No fluff. No theory. Just what works, what doesn’t, and what you need to know before talking to your doctor.