Comparative risk of cardiac arrhythmias associated with acetylcholinesterase inhibitors used in treatment of dementias – A narrative review
| Autor: | Mhd Wasem Alsabbagh, Yichang Huang |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
pharmacoepidemiology medicine.drug_class Reviews Rivastigmine Torsades de pointes Review Disease RM1-950 Alzheimer's Disease 030226 pharmacology & pharmacy 03 medical and health sciences chemistry.chemical_compound cardiac arrhythmia 0302 clinical medicine Alzheimer Disease mental disorders medicine Galantamine Animals Humans Donepezil General Pharmacology Toxicology and Pharmaceutics Intensive care medicine Adverse effect adverse drug event business.industry Arrhythmias Cardiac medicine.disease Acetylcholinesterase Neurology chemistry Acetylcholinesterase inhibitor 030220 oncology & carcinogenesis Dementia Cholinesterase Inhibitors Therapeutics. Pharmacology business medicine.drug |
| Zdroj: | Pharmacology Research & Perspectives, Vol 8, Iss 4, Pp n/a-n/a (2020) Pharmacology Research & Perspectives |
| ISSN: | 2052-1707 |
| Popis: | Donepezil, galantamine, and rivastigmine are the three acetylcholinesterase inhibitors (AChEIs), out of a total of only four medications prescribed in the treatment of Alzheimer's Disease (AD) and related dementias. These medications are known to be associated with bradycardia given their mechanism of action of increasing acetylcholine (ACh). However, in March 2015, donepezil was added to the CredibleMeds “known‐risk” category, a list where medications have a documented risk for acquired long‐QT syndrome (ALQTS) and torsades de pointes (TdP) – a malignant ventricular arrhythmia that is a different adverse event than bradycardia (and is not necessarily associated with ACh action). The purpose of this article is to review the three AChEIs, especially with regards to mechanistic differences that may explain why only donepezil poses this risk; several pharmacological mechanisms may explain why. However, from an empirical point‐of‐view, aside from some case‐reports, only a limited number of studies have generated relevant information regarding AChEIs' and electrocardiogram findings; none have specifically compared donepezil against galantamine or rivastigmine for malignant arrhythmias such as TdP. Currently, the choice of one of the three AChEIs for treatment of AD symptoms is primarily dependent upon clinician and patient preference. However, clinicians should be aware of the potential increased risk associated with donepezil. There is a need to examine the comparative risk of malignant arrhythmias among AChEIs users in real‐world practice; this may have important implications with regards to changes in AChEI prescribing patterns. |
| Databáze: | OpenAIRE |
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