Cholinesterase inhibitors and cardiovascular disease: a survey of old age psychiatrists' practice

Malone, Darren; Lindesay, James

doi:10.1093/ageing/afm002

Cited by 25 publications

(26 citation statements)

References 2 publications

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“…Therefore, concomitant use of donepezil and β-blocker(s) would require the need for close monitoring of pulse rate, postural blood pressure, given that the vagotonic effects of donepezil on heart rate can trigger bradycardia or syncope and contribute to falls (Bordier et al, 2005;Rowland et al, 2007;Best Practice Advocacy Centre, 2010b;National Institute for Health and Care Excellence, 2015). Guidelines for monitoring ECG readings at baseline are still unclear, but have been supported by Malone and Lindesay (2007). Manufacturers of donepezil have a cautionary advice for patients taking digoxin and β-blockers (Rex Medical Limited, 2010).…”

Section: Discussionmentioning

confidence: 99%

Temporal trends for donepezil utilization among older people

Ndukwe

Nishtala

2016

International Clinical Psychopharmacology

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To examine and characterize overall donepezil and concomitant utilization with β-blockers, yearly, in older New Zealanders. Deidentified data from the Pharmaceutical claims database and the National Minimum Dataset were obtained for 2011 to 2013 from the Ministry of Health. Population-level data were extracted for donepezil and β-blockers utilization, measured by defined daily dose (DDD) per thousand older people per day (TOPD). Donepezil utilization increased from 5.2 to 8.2 DDD/TOPD between 2011 and 2013. In 2011, the number of prevalent users was 4634, the mean age was 79.4±6.6 years and 57.5% were women. Highest use by age for donepezil was in those aged 85 years or older (2.3 DDD/TOPD), followed by those aged 80-84 years (2.2 DDD/TOPD). The mean utilization volumes were significantly lower for donepezil 5 mg (Student t-test=9.86; P<0.05) and 10 mg (10.90; P<0.05) in the 65- to 69-year age group compared with the 80- to 84-year age group, whereas the proportion of concomitant utilization of donepezil with β-blockers decreased (17.9% to 5.1%). Donepezil utilization in DDD/TOPD increased by three-fifths between 2011 and 2013. Prescribers appear to be aware of the potential risk of bradycardia with the concomitant use of donepezil and β-blockers.

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Section: Discussionmentioning

confidence: 99%

Temporal trends for donepezil utilization among older people

Ndukwe

Nishtala

2016

International Clinical Psychopharmacology

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“…Some have recommended that an electrocardiogram be done before treatment, to identify potentially important conduction abnormalities and to serve as a baseline assessment for future use (if needed). 38 In practice, the incidence of adverse cardiovascular events has not been high. 39 If pharmacotherapy is initiated, patients should be followed carefully for the development of adverse effects and reevaluated to determine their response to therapy after a reasonable trial (3-6 months).…”

Section: Effectivenessmentioning

confidence: 99%

Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia

Hogan¹,

Bailey²,

Black³

et al. 2008

Canadian Medical Association Journal

133

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“…Since the heart is rich in cholinesterase, its inhibition may adversely affect cardiac function, which, in turn, can cause risks, especially in elderly patients with cardiovascular disease. These cardiac adverse effects, including bradycardia, heart block and QT prolongation with or without a history of cardiac disease, can emerge as vagotonic effects due to ChEIs (3,4). QT prolongation may lead to lifethreatening ventricular arrhythmias (i.e., torsade de pointes and ventricular fibrillation) (5).…”

Section: Introductionmentioning

confidence: 99%

Cardiac Safety of Donepezil in Elderly Patients with Alzheimer Disease

et al. 2012

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Objective Donepezil is a widely used cholinesterase inhibitor for the treatment of Alzheimer's disease (AD), however its cholinergic adverse side effects on the cardiovascular system are still unclear. In this study, we aimed to examine the adverse side effects caused by donepezil on cardiac rhythm and postural blood pressure changes in elderly patients with Alzheimer Disease. Methods The ECG parameters including heart rate, PR, QT, QTc interval and QRS duration and postural blood pressure changes were recorded at the baseline and at each donepezil dose level (5 and 10 mg/d). Patients Seventy-one consecutive patients who were referred by primary care centers to a Geriatric Clinic were enrolled and underwent comprehensive geriatric assessment. Results Fifty-two subjects completed the study. There were no significant changes relative to the baseline in any of the ECG parameters or arterial blood pressure at any of the investigated dosages of donepezil. Conclusion It was demonstrated that donepezil was not associated with increased negative chronotropic, arrhythmogenic or hypotensive effects for elderly patients with Alzheimer's disease.

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Cholinesterase inhibitors and cardiovascular disease: a survey of old age psychiatrists' practice

Cited by 25 publications

References 2 publications

Temporal trends for donepezil utilization among older people

Temporal trends for donepezil utilization among older people

Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia

Cardiac Safety of Donepezil in Elderly Patients with Alzheimer Disease

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