Cholinesterase inhibitors
- Increase synaptic acetylcholine
- Donepezil/rivastigmine/galantamine: dementia
- Symptomatic benefit; do not stop neurodegeneration
- Rivastigmine also has Parkinson-dementia use
- Nausea/diarrhea + weight loss
- Bradycardia/syncope can occur
- Avoid reflex discontinuation in stable benefit
Class at a glance
- Increase synaptic acetylcholine
Members / distinctions
- Donepezil/rivastigmine/galantamine: dementia
- Symptomatic benefit; do not stop neurodegeneration
Safety / monitoring
- Rivastigmine also has Parkinson-dementia use
- Nausea/diarrhea + weight loss
- Bradycardia/syncope can occur
Safety distinctions
- Avoid reflex discontinuation in stable benefit
Pearls
- None approved for Lewy body, vascular, or frontotemporal dementia
- Raise fall and hip-fracture risk in older adults
- Caution: peptic ulcer/GI bleeding risk, asthma, COPD
- GI effects worst early; titrate slowly
Self-check
- Which cholinesterase inhibitor also has Parkinson-dementia use?
Rivastigmine. - What important cardiac adverse effects can occur?
Bradycardia and syncope.
Drugs in this class (9)
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