In the JournalsPerspective

Donepezil carries higher hospitalization risk than other Alzheimer’s drugs

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.

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.

    Perspective
    Keith N. Fargo

    Keith N. Fargo

    The study by Fleet and colleagues is important. However, based on the very small differences that were observed among the patients in the study, and the very small risk of these patients being hospitalized for rhabdomyolysis, it is far too early to be reconsidering donepezil as a drug for managing the symptoms in patients with Alzheimer’s.

    Donepezil, rivastigmine and galantamine the other cholinesterase inhibitors that researchers in this study looked atare all very well-tolerated in most patients, except for some minor gastrointestinal discomfort. Since these medications come in various formulations (patch, pill, etc.), primary care physicians should discuss with patients their preferences on intake and use that information to help steer the patient toward the medication that may be best for them.

    • Keith N. Fargo, PhD
    • Director of scientific programs and outreach
      Alzheimer’s Association

    Disclosures: Fargo reports no relevant financial disclosures.