drug adverse effects of cholinesterase inhibitors
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Adverse effects
- miosis
- increased tone of skeletal & intestinal musculature
- constriction of bronchi
- constriction of ureters, detrusor urinary frequency, urinary incontinence (2%)
- bradycardia, HR=1.69
- stimulation of secretion by salivary glands & sweat glands
- syncope, HR=1.76[1][2]
- higher rates of permanent pacemaker insertion, HR=1.49
- falls
- hip fracture HR= 1.18
- deprescribing cholinesterase inhibitors in nursing home residents associated with lower risks for serious falls & fractures[5]
- in patients with cognitive impairment, cholinesterase inhibitors reduce risk of falls[9]
- confusion
- insomnia[4], abnormal dreams
- unintentional weight loss (10-pound weight loss over 12 months) in demented patients: 29% vs 23% (placebo); NNH = 21[3][7][8]
Notes
- deprescribing cholinesterase inhibitors may result in worse cognitive, neuropsychiatric & functional status vs continuing treatment but certainty is low to very low[6]
- deprescribing cholinesterase inhibitors in nursing home residents with advanced dementia not associated with negative outcomes[5]
More general terms
References
- ↑ 1.0 1.1 Gill SS et al, Syncope and Its Consequences in Patients With Dementia Receiving Cholinesterase Inhibitors Arch Intern Med. 2009;169(9):867-873 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19433698
- ↑ 2.0 2.1 Kim DH, Brown RT, Ding EL, et al. Dementia medications and risk of falls, syncope, and related adverse events: meta-analysis of randomized controlled trials. J Am Geriatr Soc 2011; 59:1019-1031 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21649634
- ↑ 3.0 3.1 Sheffrin M et al. Weight loss associated with cholinesterase inhibitors in individuals with dementia in a national healthcare system. J Am Geriatr Soc 2015 Aug; 63:1512 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26234945
- ↑ 4.0 4.1 Medical Knowledge Self Assessment Program (MKSAP) 17, 18 American College of Physicians, Philadelphia 2015, 2018
- ↑ 5.0 5.1 5.2 Niznik JD, Zhao X, He M et al. Risk for health events after deprescribing acetylcholinesterase inhibitors in nursing home residents with severe dementia. J Am Geriatr Soc 2020 Apr; 68:699-707 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31769507 https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16241
- ↑ 6.0 6.1 Parsons C, Lim WY, Loy C et al Withdrawal or continuation of cholinesterase inhibitors or memantine or both, in people with dementia. Cochrane Database of Systematic Reviews. 2021. Feb 3. Not indexed in PubMed https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009081.pub2/full
- ↑ 7.0 7.1 Soysal P, Isik AT, Stubbs B et al. Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2016 Dec;87(12):1368-1374 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27261502 https://jnnp.bmj.com/content/87/12/1368
- ↑ 8.0 8.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ 9.0 9.1 Ahuja M, Siddhpuria S, Karimi A et al. Cholinesterase inhibitors and falls, syncope and injuries in patients with cognitive impairment: a systematic review and meta-analysis. Age Ageing. 2023 Nov 2;52(11):afad205 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37993407