Donepezil-associated bradyarrhythmia in a patient with dementia with Lewy bodies (DLB).
Dementia with Lewy bodies (DLB) is a neurodegenerative condition that results in loss of mesopontine cholinergic neurons and sympathetic deinnervation. Although acetylcholinesterase inhibitors have been shown to improve cognitive and behavioral deficits in DLB, these patients may be more susceptible to bradyarrhythmic side effects from this class of drugs due to the autonomic insufficiency associated with the disease. We present a patient who experienced a dose-dependent, symptomatic sinus bradyarrhythmia with donepezil doses at and greater than 5 mg. Owing to underlying autonomic dysfunction, patients with DLB may be at increased risk of bradyarrhythmia resulting from treatment with acetylcholinesterase inhibitors.
Rosenbloom
Michael H
MH
Department of Neurology, University of California, San Francisco Memory and Aging Center, San Francisco, CA, USA. mrosenbloom@memory.ucsf.edu
Finley
Richard
R
Scheinman
Melvin M
MM
Feldman
Mitchell D
MD
Miller
Bruce L
BL
Rabinovici
Gil D
GD
D000368:Aged; D001919:Bradycardia / Q000139:chemically induced*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000077265:Donepezil; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007189:Indans / Q000008:administration & dosage / Q000009:adverse effects*; D020961:Lewy Body Disease / Q000188:drug therapy*; D008297:Male; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects*
D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil