Cardiac safety of rivastigmine in Lewy body and Parkinson's disease dementias.
Cholinesterase inhibition in patients with Alzheimer's disease (AD) may affect heart rate, sometimes inducing bradycardia. Additional cardiac safety considerations apply in patients with dementia with Lewy bodies (DLB) and Parkinson's disease (PDD), in whom cardiovascular autonomic nervous system dysfunction is common. We conducted a review of the safety data available for rivastigmine in these two conditions. A modest reduction in the mean heart rate of 1.5-2 bpm was seen. No clinically meaningful treatment differences in bradycardia or ECG abnormalities were apparent. Compared with placebo, rivastigmine appeared to be associated with fewer vascular disorder adverse events (AEs) (p = 0.002) and fewer AEs of syncope (p = 0.018) in PDD patients (n = 541). A smaller randomised, placebo-controlled study of rivastigmine in DLB (n = 120) showed similar findings. Rivastigmine appears to have a favourable cardiac safety profile in PDD and DLB patients.
Ballard
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C
King's College, London, UK. clive.ballard@kcl.ac.uk
Lane
R
R
Barone
P
P
Ferrara
R
R
Tekin
S
S
D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced*; D006801:Humans; D020961:Lewy Body Disease / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D018696:Neuroprotective Agents / Q000009:adverse effects*; D010300:Parkinson Disease / Q000188:drug therapy*; D048448:Phenylcarbamates / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D000068836:Rivastigmine
D002800:Cholinesterase Inhibitors; D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D000068836:Rivastigmine