From the FDA Drug Label
Because rivastigmine increases cholinergic activity, use of rivastigmine may have vagotonic effects on heart rate (e.g., bradycardia). Additive bradycardic effects resulting in syncope may occur when rivastigmine tartrate is used concomitantly with beta-blockers, especially cardioselective beta-blockers (including atenolol).
Yes, Exelon (Rivastigmine) can cause bradycardia due to its vagotonic effects on heart rate. Additionally, concomitant use with beta-blockers may increase the risk of additive bradycardic effects and syncope 1 1.
From the Research
Yes, Exelon (rivastigmine) can cause bradycardia as a side effect, as evidenced by a study published in 2020 2, which found that 8 out of 57 patients with dementia with Lewy bodies developed bradycardia while taking transdermal rivastigmine.
Mechanism of Action
Exelon is a cholinesterase inhibitor that increases acetylcholine levels in the brain, which can also affect the parasympathetic nervous system throughout the body, including the heart. Increased cholinergic activity can slow heart rate, potentially leading to bradycardia (heart rate below 60 beats per minute). This effect is more likely to occur in elderly patients, those with pre-existing cardiac conditions, or patients taking other medications that affect heart rate.
Clinical Implications
Patients taking Exelon should be monitored for cardiovascular side effects, especially during dose initiation or adjustment. If bradycardia develops and causes symptoms like dizziness, fatigue, or fainting, medical attention should be sought immediately, as dosage adjustment or medication change may be necessary. Other cardiac effects may include hypotension and syncope in some patients. A case report published in 2010 3 highlights the potential cardiotoxic reaction involving rivastigmine and beta-blockers, emphasizing the need for caution when combining these medications.
Monitoring and Management
The study published in 2020 2 found that transdermal rivastigmine therapy is not associated with arrhythmogenic or hypotensive effects in elderly patients with dementia with Lewy bodies. However, physicians should pay attention to newly emerging orthostatic hypotension during follow-up in these patients. The 2021 study 4 on steroid-induced sinus bradycardia also underscores the importance of monitoring patients for cardiac side effects when taking medications that can affect heart rate.
Key Points
- Exelon (rivastigmine) can cause bradycardia as a side effect
- Increased cholinergic activity can slow heart rate, potentially leading to bradycardia
- Patients taking Exelon should be monitored for cardiovascular side effects, especially during dose initiation or adjustment
- If bradycardia develops and causes symptoms, medical attention should be sought immediately
- Other cardiac effects may include hypotension and syncope in some patients, as reported in studies such as 3 and 2.