Cholinesterase inhibitors are a class of drugs widely used to treat patients with Alzheimer's disease and other forms of dementia.


Approved agent in class:

(1) tacrine (Cognex)

(2) donepezil (Aricept, Esai/Pfizer)

(3) rivastigmine (Excelon, Ortho-McNeil)

(4) galantamine (Razadyne, Novartis)


Effect: decreased degradation of acetylcholine, resulting in increased cholinergic effects


Adverse side effects:

(1) nausea and vomiting

(2) abdominal cramps or pain

(3) diarrhea

(4) anorexia and weight loss

(5) bradycardia

(6) syncope and dizziness

(7) insomnia

(8) fatigue

(9) malaise

(10) increased sweating

(11) miosis with blurred vision


Risk factors for adverse effects:

(1) starting therapy or increasing dose

(2) higher dosage

(3) therapy with another cholinergic agent

(4) taking the dose on an empty stomach (gastrointestinal side effects)

(5) pre-existing bradycardia, sick sinus syndrome, or cardiac conduction disorder


Patients should not be treated with an anticholinergic agent, which can decreases both therapeutic and adverse effects.


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