October 02, 2019
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Donepezil carries higher hospitalization risk than other Alzheimer’s drugs

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Older patients prescribed donepezil had a higher risk for hospital admission for rhabdomyolysis than patients prescribed rivastigmine or galantamine, according to a population-based cohort study published in the Canadian Medical Association Journal.

However, the proportion of patients who develop severe rhabdomyolysis within 30 days of initiating donepezil — the leading cholinesterase inhibitor used for Alzheimer’s disease — is “very low,” researchers said.

Jamie L. Fleet, PhD, of the department of physical medicine and rehabilitation at McMaster University in Hamilton in Ontario, Canada, and colleagues reviewed records from patients (mean age, 81.1 years; 61.4% women) recently prescribed donepezil (n = 152,300) or rivastigmine or galantamine (n = 68,053). Patients were followed for 30 days from the index date of their respective prescription.

Fleet and colleagues found that donepezil was associated with a higher risk for hospital admission due to rhabdomyolysis compared with rivastigmine or galantamine (weighted OR = 2.21; 95% CI, 1.52-3.22).

Older woman in hospital bed 
Older patients prescribed donepezil had a higher risk for hospital admission for rhabdomyolysis than patients prescribed rivastigmine or galantamine, according to a population-based cohort study published in the Canadian Medical Association Journal.
Source:Shutterstock

“If patients on donepezil describe symptoms of muscle cramping, it would be prudent to consider a diagnosis of rhabdomyolysis and measure creatine kinase levels,” Fleet and colleagues wrote. “In patients at high risk of rhabdomyolysis, including a prior history of the condition, it may be reasonable to initiate a different cholinesterase inhibitor,” they added. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.