Cardiac and Blood Pressure Safety of Transdermal Rivastigmine in Elderly Patients With Dementia With Lewy Bodies

Abstract

Background: Dementia with Lewy bodies (DLB) is the second most common dementia. Features of DLB include postganglionic cardiac sympathetic denervation and autonomic instability. Rivastigmine therapy, an acetylcholinesterase inhibitor, is widely used in the primary treatment of DLB; however, the cardiovascular safety and tolerability of transdermal rivastigmine needs to be reviewed. Objective: To evaluate whether transdermal rivastigmine has an effect on blood pressure, heart rate, and electrocardiography measurements. Materials and Methods: A total of 722 patients diagnosed with dementia were retrospectively screened. Fifty-seven of 98 DLB patients who received transdermal rivastigmine treatment with available serial electrocardiography and blood pressure measurements were included in the study. Baseline and follow-up measurements were compared for patients on the 9.5 to 13.3 mg/d rivastigmine dose for at least 4 weeks. Results: The mean age of the patients was 80.77±6.04, and the majority were women (63%). A total of 8 cases with bradycardia and 5 with orthostatic hypotension were detected during follow-up, and rivastigmine patch was stopped in one of those 8 patients due to symptomatic bradycardia. Nonetheless, there was no difference between baseline and follow-up measurements of the patients, including heart rate, cardiac rhythm, electrocardiographic intervals, blood pressure, pulse pressure, and postural blood pressure changes. Conclusions: Transdermal rivastigmine therapy is not associated with arrhythmogenic or hypotensive effects in the elderly patients with DLB. However, when prescribing transdermal rivastigmine, physicians should pay attention to newly emerging orthostatic hypotension during the follow-up in these patients.

The listed, delisted, and sustainability of therapeutic medicines for dementia patients: the study is specific to South Korea

“…They observed that donepezil and galantamine amplified the spatial dispersion of repolarisation in rabbit hearts, but rivastigmine showed no increase in the spatial dispersion of repolarisation despite a pronounced prolongation of repolarisation. Furthermore, donepezil and galantamine provoked triggered activity, whereas rivastigmine did not have proarrhythmic effects (Ellermann et al 2020;Isik et al 2020). Rivastigmine's crucial safety concern is the risk of treatment overdose by administering multiple patches simultaneously, potentially leading to fatal outcomes (Khoury et al 2018;Kazmierski et al 2018;Eijk et al 2010).…”

Postprandial Hypotension Is More Common Than Orthostatic Hypotension In Older Adults With Dementia With Lewy Bodies: A Cross-Sectional Study

“…[8, 9, 14] However, to the best of our knowledge, this is the rst study to report the increased risk of PPH in DLB patients. Considering both DLB-related negative health outcomes, [9,13,21,29] and adverse events and complications related to OH and PPH, as signs of dysautonomia, it is clear that the prevention of such outcomes is indispensable to ensure better management of DLB. [8, 9,14] Although delayed OH was signi cantly higher in DLB patients than in control, this difference between the groups disappeared after the adjustment.…”

“…[12] It is not only one of the supportive clinical features of the DLB but also leads to complexity in the management of patients and increases disease burden. [13] Although there is much evidence of how important OH is in DLB patients clinically, [14] other postprandial and postural blood pressure changes in DLB, such as, postprandial hypotension (PPH), orthostatic hypertension (OHT) and supine hypertension (HT), in such patients have not been studied in detail yet. Therefore, the study aimed to show the prevalence of blood pressure changes in DLB patients.…”

The Relationship between the Most Common Subtypes of Dementia and Orthostatic Hypotension in Older Adults

“…This result is similar to the study of Kleipool et al [5], where OH was evaluated with an active standing test. Additionally, in a recent study, we showed that under cholinomimetic therapy, OH can occur in DLB patients [23].…”