Bradycardia due to cholinesterase inhibitors: identify adverse effects and take them into account

The cholinesterase inhibitors donepezil, rivastigmine and galantamine have a modest and transient benefit in Alzheimer's disease. Their known adverse effects include bradycardia. A Canadian case-control study conducted between 2003 and 2008 showed a statistically significant increase in the risk of hospitalisation for bradycardia among patients who had been taking a cholinesterase inhibitor for less than 3 months, compared with patients who had stopped taking a cholinesterase inhibitor more than 6 months previously. After hospital discharge, more than half of these patients were again prescribed a cholinesterase inhibitor, and 4% of them were re-admitted for bradycardia. In practice, when an adverse effect has been identified and treated, this information must be shared and taken into account by all those involved in the patient's subsequent management.