CHOLINESTERASE INHIBITORS FOR ALZHEIMER’S DISEASE AND THE HEART: AN UPDATE

Acetylcholinesterase inhibitors (AChEIs) are widely used in the symptomatic treatment of Alzheimer's disease, a disease that is afflicting a major part of our greying population. Their mechanism of action is based upon non-specific cholinergic stimulation, thereby potentially inducing cardiac beneficial or adverse effects. Data of large observational studies demonstrated a small but significant cardiac risk for all registered AChEIs (donepezil, galantamine and rivastigmine) not observed in previous clinical trials. This might be explained by a non-selective approach for prescribing AChEIs, thereby also including older persons with coexisting diseases or using several drugs, opposed to a selective patient recruitment in trials. Although there is no consensus on the management, we recommend attentiveness for cardiac symptoms and heart rhythm in every patient treated with AChEIs, and plea for a vigilant use of AChEIs in elderly patients at increased risk for cardiac adverse effects.

Jaar van publicatie:2014