The Hospice Clinician Blog

Dementia Drugs Linked to Serious Adverse Events

The Cholinesterase inhibitors include Aricept, Exelon, and Razadyne. These drugs are commonly used for treating patients with dementia and recently have been linked to serious adverse effects in elderly patients with dementia.

The May 11, 2009  issue of the Archives of Internal Medicine contains an article which describes the results of a large population-based cohort study that indicated cholinesterase inhibitor use is associated with an increased incidence of syncope-related events. The investigators used healthcare databases from Ontario, Canada for a 2 year period from 2002 to 2004. They compared 19,803 community- dwelling older adults with dementia who were prescribed cholinesterase inhibitors against 61,499 control subjects who were not using these medications.

Participants receiving cholinesterase inhibitors had significantly more frequent hospital visits for syncope than the control participants. The participants on the medications also had a higher frequency of syncope related events including bradycardia, permanent pacemaker insertion, and hip fracture.

The investigators concluded that these drugs can provoke symptomatic bradycardia and syncope, which may lead to permanent pacemaker insertion. Drug induced syncope may also precipitate fall-related injuries, including hip fracture. These drugs are widely used to treat dementia and clinical trials have demonstrated some modest improvements in cognition and statistical function scoring tests, especially in early stages of dementia. In later stages of the disease, or after 2 years of cholinesterase inhibitor therapy, the rates of disease progression and rates of institutionalization were similar between the cholinesterase drugs and placebo.

These drugs are often not covered by hospice due to lack of proven effectiveness in advanced dementia. Now, given this latest report, the risk of serious side effects must also be carefully weighed against the relatively modest benefits of cholinesterase inhibitor drug therapy in dementia.

Photo Credit: DerrickT

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