Is Rhabdomyolysis A Side Effect For Aricept, Only, Or For Other Cholinesterase Inhibitors, Also?
Back in January 2015 Health Canada issued a postmarket surveillance warning about a risk of rhabdomyolysis with Aricept (donepezil), a drug commonly used to manage cognitive decline in Alzheimer’s patients.
More recently, this study was published online September 16, 2019 in CMAJ (Canadian Medical Association Journal), "Risk of rhabdomyolysis with donepezil compared with rivastigmine or galantamine: a population-based cohort study".
From the Abstract for this 2019 CMAJ medical journal article we get the following:
BACKGROUND: [Aricept (donepezil), Exelon (rivastigmine), and Razadyne (galantamine)] are popular cholinesterase inhibitors used to manage the symptoms of Alzheimer disease and other dementias; regulatory agencies in several countries warn about a possible risk of rhabdomyolysis with [Aricept (donepezil)], based on information from case reports. Our goal was to investigate the 30-day risk of admission to hospital with rhabdomyolysis associated with initiating [Aricept (donepezil)] versus other cholinesterase inhibitors.
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From a September 19, 2019 Medscape article, "Alzheimer's Drug Linked to Potentially Serious Muscle Condition", we get this summary of the underlying study:
The Alzheimer's drug donepezil (multiple brands) is associated with a twofold higher risk for hospital admission for rhabdomyolysis, a rare but potentially life-threatening condition in which muscle cells break down. It can lead to kidney damage.
Results of a population-based study showed that use of donepezil was associated [with] a significantly higher risk for rhabdomyolysis compared to other cholinesterase inhibitors, although the investigators note that the absolute risk was small.
"Clinicians should have an index of suspicion to check for rhabdomyolysis if patients on donepezil present with muscle weakness or pain," study investigator Jamie Fleet, MD, Department of Physical Medicine and Rehabilitation at McMaster University, Hamilton, Ontario, Canada, told Medscape Medical News.
We point out that this study only included adults older than the age of 65, so it is unknown whether these findings may be generalizable to adults below that age with Alzheimer disease and other dementia
Further, there is uncertainty about whether rhabdomyolysis is a side effect for Aricept, only, or for other cholinesterase inhibitors, also. As regards this issue, we return to the Medscape news report about the study:
Reached for comment, Gregory Jicha, MD, PhD, of the Sanders-Brown Center on Aging, University of Kentucky, Lexington, noted that a "small subset of patients can experience muscle cramping as one of the side effects of cholinesterase inhibitors.
"This is something that has been watched for some time. This very large study certainly puts it on our radar; but that said, this is an incredibly rare side effect, and in the majority of the patients, the symptoms were quite mild," Jicha told Medscape Medical News....
In addition, Jicha said he does not believe donepezil should be singled out.
"From a scientific plausibility standpoint, it doesn't make sense that one cholinesterase inhibitor would be worse than another. It could be that the groups in this study were imbalanced," he said.
We will watch for further developments about Aricept associated with rhabdomyolysis, including a possible Aricept label change with increased muscle injury side effect warnings in the US.
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