Donepezil-induced bradycardia in a schizophrenic patient with comorbid neurocognitive disorder: a case report and review of the literature.
Anticholinesterase inhibitor
Bradycardia
Donepezil
Schizophrenia
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
27 Mar 2024
27 Mar 2024
Historique:
received:
23
05
2023
accepted:
12
02
2024
medline:
27
3
2024
pubmed:
27
3
2024
entrez:
27
3
2024
Statut:
epublish
Résumé
Trials of cholinergic and glutamatergic agents have improved cognition and memory for the geriatric schizophrenic population. Donepezil is an acetylcholinesterase inhibitor that improves cognition by preventing postsynaptic degradation of hippocampal acetylcholine in patients with mild-to-moderate dementia. Donepezil has been attributed to some adverse effects, especially gastrointestinal symptoms. However, cardiovascular adverse effects are not common as there remains a dearth of literature regarding donepezil-induced bradycardia. Hence, we present the case of a 70-year-old Hispanic female with past psychiatry history of schizophrenia who developed bradycardia and syncope following the commencement of low-dose donepezil in the inpatient unit and subsequent resolution with cessation. She had no prior cardiovascular symptoms or diagnosis. Considering there is no baseline cardiac monitoring requirement guideline for patients on Donepezil treatment, pre-assessment electrocardiogram is advised before the commencement of acetylcholinesterase inhibitors. Finally, routine monitoring of vital signs for at least the first 72 hours following the start of donepezil might be good proactive practice for all psychiatrists. Extending this practice to inpatient and outpatient service settings will be worthwhile.
Sections du résumé
BACKGROUND
BACKGROUND
Trials of cholinergic and glutamatergic agents have improved cognition and memory for the geriatric schizophrenic population. Donepezil is an acetylcholinesterase inhibitor that improves cognition by preventing postsynaptic degradation of hippocampal acetylcholine in patients with mild-to-moderate dementia. Donepezil has been attributed to some adverse effects, especially gastrointestinal symptoms. However, cardiovascular adverse effects are not common as there remains a dearth of literature regarding donepezil-induced bradycardia.
CASE REPORT
METHODS
Hence, we present the case of a 70-year-old Hispanic female with past psychiatry history of schizophrenia who developed bradycardia and syncope following the commencement of low-dose donepezil in the inpatient unit and subsequent resolution with cessation. She had no prior cardiovascular symptoms or diagnosis.
DISCUSSION
CONCLUSIONS
Considering there is no baseline cardiac monitoring requirement guideline for patients on Donepezil treatment, pre-assessment electrocardiogram is advised before the commencement of acetylcholinesterase inhibitors. Finally, routine monitoring of vital signs for at least the first 72 hours following the start of donepezil might be good proactive practice for all psychiatrists. Extending this practice to inpatient and outpatient service settings will be worthwhile.
Identifiants
pubmed: 38532522
doi: 10.1186/s13256-024-04454-x
pii: 10.1186/s13256-024-04454-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
129Informations de copyright
© 2024. The Author(s).
Références
Ferreira-Vieira TH, Guimaraes IM, Silva FR, Ribeiro FM. Alzheimer’s disease: targeting the cholinergic system. Curr Neuropharmacol. 2016;14(1):101–15. https://doi.org/10.2174/1570159x13666150716165726 .
doi: 10.2174/1570159x13666150716165726
pubmed: 26813123
pmcid: 4787279
Di Angelantonio S, Bernardi G, Mercuri NB. Donepezil modulates nicotinic receptors of substantia nigra dopaminergic neurones. Br J Pharmacol. 2004;141(4):644–52. https://doi.org/10.1038/sj.bjp.0705660 .
doi: 10.1038/sj.bjp.0705660
pubmed: 14744806
pmcid: 1574242
Rogers SL, Farlow MR, Doody RS, Mohs R, Friedhoff LT. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer’s disease. Donepezil Study Group. Neurology. 1998;50(1):136–45. https://doi.org/10.1212/wnl.50.1.136 .
doi: 10.1212/wnl.50.1.136
pubmed: 9443470
Greenberg SM, Tennis MK, Brown LB, et al. Donepezil therapy in clinical practice: a randomized crossover study. Arch Neurol. 2000;57(1):94–9. https://doi.org/10.1001/archneur.57.1.94 .
doi: 10.1001/archneur.57.1.94
pubmed: 10634454
Kuwahata S, Takenaka T, Motoya T, et al. Effect of QT prolongation in patients taking cholinesterase inhibitors (donepezil) for Alzheimer’s disease. Circul Rep. 2021;3(3):115–21. https://doi.org/10.1253/circrep.CR-20-0115 .
doi: 10.1253/circrep.CR-20-0115
Howard RJ, Juszczak E, Ballard CG, et al. Donepezil for the treatment of agitation in Alzheimer’s disease. N Engl J Med. 2007;357(14):1382–92. https://doi.org/10.1056/NEJMoa066583 .
doi: 10.1056/NEJMoa066583
pubmed: 17914039
Hashimoto M, Kazui H, Matsumoto K, Nakano Y, Yasuda M, Mori E. Does donepezil treatment slow the progression of hippocampal atrophy in patients with Alzheimer’s disease? Am J Psychiatry. 2005;162(4):676–82. https://doi.org/10.1176/appi.ajp.162.4.676 .
doi: 10.1176/appi.ajp.162.4.676
Jackson S, Ham RJ, Wilkinson D. The safety and tolerability of donepezil in patients with Alzheimer’s disease. Br J Clin Pharmacol. 2004;58(Suppl 1):1–8. https://doi.org/10.1111/j.1365-2125.2004.01848.x .
doi: 10.1111/j.1365-2125.2004.01848.x
pubmed: 15496217
pmcid: 1884556
Howes LG. Cardiovascular effects of drugs used to treat Alzheimer’s disease. Drug safety. 2014;37(6):391–5. https://doi.org/10.1007/s40264-014-0161-z .
doi: 10.1007/s40264-014-0161-z
pubmed: 24777654
Rosenbloom MH, Finley R, Scheinman MM, Feldman MD, Miller BL, Rabinovici GD. Donepezil-associated bradyarrhythmia in a patient with dementia with Lewy bodies (DLB). Alzheimer Dis Assoc Disord. 2010;24(2):209–11. https://doi.org/10.1097/WAD.0b013e3181b7642b .
doi: 10.1097/WAD.0b013e3181b7642b
pubmed: 20505440
pmcid: 2879079
Mehta AV, Chidambaram B, Garrett A. Familial symptomatic sinus bradycardia: autosomal dominant inheritance. Pediatr Cardiol. 1995;16(5):231–4. https://doi.org/10.1007/bf00795713 .
doi: 10.1007/bf00795713
pubmed: 8524708
Kokras N, Stamouli E, Sotiropoulos I, et al. Acetyl cholinesterase inhibitors and cell-derived peripheral inflammatory cytokines in early stages of Alzheimer’s disease. J Clin Psychopharmacol. 2018;38(2):138–43. https://doi.org/10.1097/jcp.0000000000000840 .
doi: 10.1097/jcp.0000000000000840
pubmed: 29420357
Bordier P, Lanusse S, Garrigue S, et al. Causes of syncope in patients with Alzheimer’s disease treated with donepezil. Drugs Aging. 2005;22(8):687–94. https://doi.org/10.2165/00002512-200522080-00005 .
doi: 10.2165/00002512-200522080-00005
pubmed: 16060718
Montero-Odasso M, Speechley M, Chertkow H, et al. Donepezil for gait and falls in mild cognitive impairment: a randomized controlled trial. Eur J Neurol. 2019;26(4):651–9. https://doi.org/10.1111/ene.13872 .
doi: 10.1111/ene.13872
pubmed: 30565793
Knudtzen FC, Christophersen TB. Third degree atrioventricular block associated with treatment with rivastigmine transdermal patch. J Geriatr Cardiol JGC. 2013;10(1):113–5. https://doi.org/10.3969/j.issn.1671-5411.2013.01.017 .
doi: 10.3969/j.issn.1671-5411.2013.01.017
pubmed: 23610582
Basselin M, Nguyen HN, Chang L, Bell JM, Rapoport SI. Acute but not chronic donepezil increases muscarinic receptor-mediated signaling via arachidonic acid in unanesthetized rats. J Alzheimer’s Dis JAD. 2009;17(2):369–82. https://doi.org/10.3233/jad-2009-1058 .
doi: 10.3233/jad-2009-1058
pubmed: 19363262
Sadowsky CH, Dengiz A, Olin JT, Koumaras B, Meng X, Brannan S. Switching from donepezil tablets to rivastigmine transdermal patch in Alzheimer’s disease. Am J Alzheimer’s Dis Dement. 2009;24(3):267–75. https://doi.org/10.1177/1533317509333037 .
doi: 10.1177/1533317509333037