From the Guidelines
Aricept (donepezil) can indeed cause decreased heart rate (bradycardia) as a side effect, and safer alternatives for treating dementia with less cardiac impact include Namenda (memantine). This occurs because Aricept is an acetylcholinesterase inhibitor that increases acetylcholine levels, which can stimulate the parasympathetic nervous system and slow heart rate 1. The evidence suggests that cholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine, can cause bradycardia and other cardiovascular side effects 1.
Alternatives to Aricept
Some alternatives to Aricept include:
- Namenda (memantine), which works through a different mechanism (NMDA receptor antagonism) and typically has fewer cardiovascular side effects
- Exelon (rivastigmine) or Razadyne (galantamine), though these are also cholinesterase inhibitors and may still affect heart rate, but possibly to a lesser extent in some patients 1
- Non-pharmacological approaches like cognitive stimulation therapy or lifestyle modifications to complement medication treatment
Important Considerations
If you're experiencing bradycardia on Aricept, don't stop taking it suddenly; consult your healthcare provider who might adjust your dosage, switch medications, or monitor your heart function more closely 1. The choice of alternative depends on your specific type of dementia, overall health status, and other medications you may be taking. It's essential to weigh the benefits and risks of each medication and consider individual patient factors when making treatment decisions 1.
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 are likely to exaggerate succinylcholine-type muscle relaxation during anesthesia. Cholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes manifesting as bradycardia or heart block
Donepezil (Aricept) can cause a decreased heart rate (HR), as it may have vagotonic effects on the sinoatrial and atrioventricular nodes, manifesting as bradycardia or heart block. Alternatives that are safe cannot be determined from the provided information, as the labels do not discuss alternative medications. 2, 2, 2
From the Research
Aricept and Heart Rate
- Aricept, also known as donepezil, is a medication used to treat Alzheimer's disease.
- Studies have shown that donepezil can decrease heart rate in patients with Alzheimer's disease 3, 4.
- A study published in 2006 found that donepezil decreased heart rate in patients with Alzheimer's disease, with a mean heart rate decrease of 4 beats per minute at 1,2, and 8 months of treatment 3.
- Another study published in 2019 found that donepezil decreased heart rate in elderly patients with Alzheimer's disease, with a significant decrease in heart rate at 4,8, and 12 weeks of treatment with 10mg of donepezil per day 4.
Alternatives to Aricept
- Other medications used to treat Alzheimer's disease include rivastigmine, galantamine, and memantine.
- Rivastigmine and galantamine are acetylcholinesterase inhibitors, similar to donepezil, and have been shown to be effective in treating Alzheimer's disease 5, 6, 7.
- Memantine is an NMDA receptor antagonist and has been shown to be effective in treating moderate to severe Alzheimer's disease 5, 6, 7.
- The cost-effectiveness of these medications has been studied, and results suggest that donepezil, rivastigmine, and galantamine may be cost-effective in certain patient populations, while memantine may be cost-effective in patients with moderate to severe Alzheimer's disease 6, 7.
Safety of Alternatives
- The safety of these medications has been studied, and results suggest that they are generally well-tolerated, but may have side effects such as gastrointestinal symptoms, dizziness, and headache 3, 5, 6, 7, 4.
- Regular cardiovascular monitoring is recommended for patients taking donepezil, as it may decrease heart rate 4.
- Patients taking rivastigmine, galantamine, and memantine should also be monitored for side effects and changes in their condition 5, 6, 7.