Syncope donepezil

Seven elderly patients with psychotic or non-psychotic behavioral symptoms in Lewy body dementia had some benefit from donepezil (24). Donepezil was withdrawn prematurely in three patients owing to poor response and/or adverse events. The adverse events were sedation, somnolence, worsening of chronic obstructive pulmonary disease, syncope, sweating, and bradycardia. These results have to be confirmed in controlled trials. 

Soon after the start of donepezil treatment three patients with Alzheimer s disease developed cardiac syncope (52). In two cases, a bradydysrhythmia was documented and pacemaker implantation was considered justified rather than donepezil withdrawal. 

The causes of syncope in patients with Alzheimer s disease treated with donepezil have been reported in 16 consecutive patients (12 women, 4 men) with Alzheimer s disease, mean age 80 years, who underwent staged evaluation, ranging from physical examination to electrophy-siological testing (54). The mean dose of donepezil was 7.8 mg/day and the mean duration of donepezil treatment at the time of syncope was 12 months. Among the causes of syncope, carotid sinus syndrome (n = 3), complete atrioventricular block (n = 2), sinus node dysfunction (n = 2), and paroxysmal atrial fibrillation (n = 1) were diagnosed. No cause of syncope was found in six patients. Non-invasive evaluation is recommended before withdrawing cholinesterase inhibitors in patients with Alzheimer s disease and unexplained syncope. 

Bordier P, Lanusse S, Garrigue S, Reynard C, Robert F, Gencel L, Lafitte A. Causes of syncope in patients with Alzheimer s disease treated with donepezil. Drugs Aging 2005 22 687-94. 

Syncopal episodes have been reported with the use of donepezil... 

Adverse effects inevitably include cholinergic symptoms with nausea, diarrhoea and abdominal cramps appearing commonly. There may also be bradycardia, sinoatrial or atrioventricular block. Urinary incontinence, syncope, convulsions, and psychiatric disturbances also occur. Rapid dose increase appears to make symptoms more pronounced. Hepatotoxicity is a rare association with donepezil. 

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