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Alzheimer's disease:
drugs cause a number of adverse effects

Anticholinesterase inhibitors are not very effective in treating Alzheimer's disease. They expose the patient to potentially serious adverse effects, which are often similar to the symptoms of the illness itself, and which can appear or be exacerbated as a result of drug interactions.

The anticholinesterase inhibitors donepezil, galantamine and rivastigmine have little effect in halting the deterioration of patients suffering from Alzheimer's disease. They carry the risk of adverse effects: mainly digestive, neurological, urinary (incontinence) and cardiovascular (comparatively high death rate with galantamine). Memantine, a derivative of amantadine, also causes many adverse effects, and its interactions with other drugs have not been widely studied. Anticholinesterase inhibitors interact with a number of drugs, which can aggravate their adverse effects. Atropinic drugs such as certain treatments for urinary incontinence, treatments for Parkinson's disease and cough medicines, can cause a worsening of the patient, the aggravation of urinary incontinence and behavioural disorders. Neuroleptics increase neurological disorders, with a higher mortality rate among patients with dementia. Some drugs slowing down the heart rate are more likely to cause fainting and irregular heartbeat. The adverse effects of cholinesterase inhibitors -- sometimes due to, or aggravated by, a drug interaction -- should be taken into account, in view of their dubious clinical benefit.

©Prescrire February 2006

Source: "Maladie d'Alzheimer: gare aux interactions avec les anticholinestérasiques" Rev Prescrire 2006 ; 26 (269) : 111-115.

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