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In the October issue of Prescrire International:
Syncope with cholinesterase inhibitors

FREE DOWNLOAD Three cholinesterase inhibitors, donepezil, galantamine and rivastigmine, are widely used as symptomatic treatment of Alzheimer's disease. Their minimal benefits do not justify exposing patients to the risk of syncope and bradycardia, and their consequences. These drugs should simply be avoided and the emphasis placed on non-drug management, however difficult.
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Summary

  • Adverse effects of cholinesterase inhibitors used in Alzheimer’s disease include cardiac disorders (bradycardia, conduction disorders) that can cause malaise and syncope.
     
  • A cohort study compared 20 000 patients who received a cholinesterase inhibitor for dementia with a control group of untreated dementia patients.
     
  • Cholinesterase inhibitor therapy was associated with statistically significant increases in hospitalisations for syncope or bradycardia, pacemaker insertion, and hip fracture.
     
  • In practice, cholinesterase inhibitors have little more than a placebo effect and do not justify exposing patients to these risks.

Full text available for free download.

©Prescrire 1 October 2011

"Syncope with cholinesterase inhibitors" Prescrire Int 2011; 20 (120) : 240. (Pdf, free)

 
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