Electrocardiogram Changes of Donepezil Administration in Elderly Patients with Ischemic Heart Disease

Abstract

Objective Donepezil, a widely used cholinesterase inhibitor for treating Alzheimer's disease, has been reported to induce bradyarrhythmias and torsade de pointes. In this study, we aimed at determining electrocardiogram changes of donepezil administration in elderly patients with ischemic heart disease, who tend to suffer from cognitive disorders. Methods Sixty patients with ischemic heart disease and mild cognitive impairment were treated with donepezil (5 mg/day) and followed up for at least four weeks. A twenty-four-hour ambulatory electrocardiogram was performed for the analysis of heart rate variability. The ECG parameters including heart rate (HR), PR and RR intervals, QT interval, and QRS duration were recorded at the baseline and after donepezil administration. Results Donepezil administration resulted in significant reduction in mean HR and the lowest HR and prolongation of PR and RR intervals, whereas it had no significant effects on QRS duration and QT parameters including QT, corrected QT interval, QT dispersion, and Tpeak-end interval. HRV analysis showed that donepezil administration significantly improved parasympathetic function, indicated by decreased low/high frequency (LF/HF) ratio and high frequency (HF) components and oscillation of RR intervals. Conclusions These data demonstrated that donepezil administration decreased HR, prolonged PR interval, and increased parasympathetic function without affecting QRS duration and QT intervals, suggesting that it can be used safely in elderly patients with ischemic heart disease.

QT interval prolongation and Torsades de Pointes with donepezil, rivastigmine and galantamine

“…found decreased heart rate and prolonged PR interval but no significant changes to QT/QT c interval in a group of 60 elderly patients with ischaemic heart disease, receiving 5 mg/day of donepezil and followed for a month. 40 Patients with bradycardia or using antiarrhythmic agents prior to the study were excluded from this study. 40 By contrast, Poluzzi et al .…”

“… 40 Patients with bradycardia or using antiarrhythmic agents prior to the study were excluded from this study. 40 By contrast, Poluzzi et al . have performed a datamining search of the public version of the FDA Adverse Event Reporting System (AERS) to find cases of reports of TdP across all drug classes.…”

Comparative risk of cardiac arrhythmias associated with acetylcholinesterase inhibitors used in treatment of dementias – A narrative review

“…Two studies that specifically analyzed donepezil treatment on a variety of ECG parameters are a study by Igeta et al, published in 2014, and a study by Wang et al, published in 2018. 45,85 The study Another study that assessed only donepezil was a population-based case-control study that analyzed co-prescribing of donepezil with antibiotics and associated bradycardia/syncope; it noted no significant differences with regards to risks and co-prescription of donepezil with different antibiotics. 86…”

The effects of acetylcholinesterase inhibitors on the heart in acute myocardial infarction and heart failure: From cells to patient reports

“…In stable angina and in exercise-induced MI patients, pyridostigmine has been shown to decrease resting heart rate and QTc interval. 139 In heart failure patients, pyridostigmine reduced resting heart rate and improved heart rate recovery and haemodynamic function after maximal exercise. 137,138 In another clinical report, donepezil improved sympathovagal balance without changing QRS duration and the QTc interval in ischaemic heart disease patients with mild cognitive impairment.…”

“…137,138 In another clinical report, donepezil improved sympathovagal balance without changing QRS duration and the QTc interval in ischaemic heart disease patients with mild cognitive impairment. 139 In heart failure patients, pyridostigmine reduced resting heart rate and improved heart rate recovery and haemodynamic function after maximal exercise. 140,141 Treatment with pyridostigmine also improved heart rate variability and reduced the occurrence of ventricular arrythmias in stable congestive heart failure patients.…”