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McMaster University researchers have found that, contrary to past warnings, commonly prescribed dementia drugs do not increase the risk of death or certain heart rhythm problems.

A systematic review and meta-analysis published in the Journal of American Geriatrics Society on April 5, 2024, investigated the drug donepezil and found that people who took the drug developed certain fatal cardiac arrhythmias related to the QT interval. We investigated whether there is a high risk of developing the disease. This is the time it takes for the heart’s electrical system to function normally and then reset, compared to someone who is not taking the drug.

Donepezil is one of the most prescribed dementia drugs, with nearly 6 million prescriptions written in the United States in 2020. The drug is prescribed to slow the progression of symptoms associated with dementia, such as memory loss, but its effectiveness is debated.

This drug can cause its own set of side effects, including nausea, loss of appetite, urinary symptoms, and diarrhea, which can be very debilitating for dementia patients.

“We found no association between donepezil and this particular fatal heart disease,” said co-lead author Tina Nam, a fifth-year geriatrics resident at McMaster University School of Medicine. says.

“For prescribers, it’s good to know that donepezil may not pose as high a risk for this fatal arrhythmia as previously thought. For patients taking donepezil, donepezil There are concerns that it can cause some bad side effects on the heart, and this review helps clarify some of those long-held beliefs.”

As part of this review, researchers analyzed 60 randomized trials involving more than 12,000 people. Researchers say there is a lack of previous studies to warn about the risk of health problems, such as previous studies involving small numbers of people or lack of appropriate comparison groups.

“Unfortunately, current dementia medications, including donepezil, fall far short of important outcomes such as allowing patients to function at home with their families, but they do not at least address concerns about cardiac arrhythmias. There appears to be no associated death or syncope (syncope).”This is an important question,” said Dr. McMaster, professor of medicine and head of the Division of Clinical Pharmacology and Toxicology, and lead author of the study. Anne Holbrook says.

“These reviews are crucial in demystifying the preconceived risks associated with drugs like donepezil. “We can ask,” says co-lead author Cristian Garcia, a second-year medical student at the University of Toronto’s Temerty Department. medicine. “We are able to delve into a deep pool of reliable evidence and provide some reassurance to patients and clinicians.”

Dementia is a growing concern as Canada’s population ages. As of January 2024, it is estimated that more than 733,000 people in Canada are living with dementia. The Alzheimer’s Association also estimates that 15 people are diagnosed with dementia every hour.

Researchers say the review could also help reduce the administrative burden for clinicians who prescribe the drug. This will be reflected in the elimination of warning labels in electronic medical records (EMRs) that previously incorrectly associated donepezil with fatal QT interval cardiac arrhythmias.

“Clinicians receive a plethora of warnings like this on the EMRs we use. Research shows that the amount of clicks required to ignore these warnings can increase caregiver burnout and caregiving.” “It has been shown that it can lead to stress among people,” says Nam.

Researchers say more research is needed to determine how safe donepezil is for different patients, including those with pre-existing heart disease.

reference: Nham T, Garcia MC, Tsang KLJ et al. Major proarrhythmogenic cardiac adverse events caused by donepezil: a systematic review with meta-analysis. J. Am Geriat Sock. 2024.Doi: 10.1111/jgs.18909

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