From the Guidelines
Yes, Aricept (donepezil) can cause bradycardia as a side effect, as indicated by the most recent and highest quality study available 1. Aricept is a cholinesterase inhibitor commonly prescribed for Alzheimer's disease that works by increasing acetylcholine levels in the brain. However, this medication doesn't just affect the brain - it also increases acetylcholine throughout the body, including at the heart. Acetylcholine naturally slows heart rate through its action on the vagus nerve, so when Aricept increases acetylcholine levels, it can lead to bradycardia (abnormally slow heart rate below 60 beats per minute).
Some key points to consider when prescribing Aricept include:
- The medication should be started at a low dose (5mg daily) and gradually increased if needed, to minimize the risk of bradycardia and other side effects.
- Patients taking Aricept should be monitored for symptoms of bradycardia, which include dizziness, weakness, fatigue, and in severe cases, fainting.
- The risk of bradycardia is typically highest when starting the medication or increasing the dose.
- Patients with pre-existing heart conditions or those taking other medications that affect heart rate are at higher risk of developing bradycardia while taking Aricept.
It's also worth noting that the evidence from 1 suggests that cholinesterase inhibitors like donepezil can cause bradycardia, and this is consistent with the mechanism of action of these medications. In contrast, older studies like 1 and 1 do not provide as clear a picture of the risk of bradycardia with Aricept, highlighting the importance of relying on the most recent and highest quality evidence when making clinical decisions. Additionally, studies like 1 provide more general guidance on the management of polypharmacy in older patients, but do not specifically address the risk of bradycardia with Aricept.
From the FDA Drug Label
Because of their pharmacological action, cholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes. This effect may manifest as bradycardia or heart block in patients both with and without known underlying cardiac conduction abnormalities. Cholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes manifesting as bradycardia or heart block
Bradycardia is a potential effect of donepezil due to its vagotonic effects on the sinoatrial and atrioventricular nodes, as stated in the drug label 2 and 2 and 2.
From the Research
Aricept and Bradycardia
- Aricept, also known as donepezil, is a medication used to treat Alzheimer's disease.
- Studies have investigated the association between donepezil and bradycardia, a condition characterized by a decrease in heart rate.
Evidence of Association
- A study published in 2021 found a significant greater likelihood of reporting bradycardia in patients administered donepezil than most of the drugs investigated 3.
- Another study published in 2019 found that donepezil decreased heart rate in elderly patients with Alzheimer's disease, with a significant correlation between donepezil dosage and heart rate 4.
- A study published in 2009 found a greater risk for bradycardia in patients taking any cholinesterase inhibitors, including donepezil, with a dose-response effect observed for donepezil 5.
Mechanism and Risk Factors
- The mechanism of action of donepezil, which increases acetylcholine, may explain the association with bradycardia 6.
- Studies have found that males are more likely to report bradycardia as an adverse event than females 3.
- The risk of bradycardia may increase with increasing doses of donepezil 5.
Clinical Implications
- Patients with Alzheimer's disease treated with donepezil should undergo regular cardiovascular monitoring 4.
- Clinicians should be aware of the potential increased risk of bradycardia associated with donepezil 6.
- Further study is needed to examine the comparative risk of malignant arrhythmias among acetylcholinesterase inhibitor users in real-world practice 6.