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Updated: Nov 29, 2025

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Donepezil induces ventricular arrhythmias by delayed repolarisation
Jason Kho1, Adam Ioannou2, Amit K J Mandal3
1Department of Cardiology and Internal Medicine, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Wexham Street, Slough, UK. jason.kho1@nhs.net.
Abstract:
Acetylcholinesterase inhibitors such as donepezil delay the progression of Alzheimer's dementia by increasing acetylcholine concentrations in the central nervous system. However, it is becoming apparent that cholinesterase inhibition by donepezil is not confined to the brain. This is supported by previous case reports of peripheral cholinergic side effects and adverse cardiac arrhythmias such as Torsades de Pointes which are reversible upon cessation of donepezil. The augmented acetylcholine concentrations and IKr inhibition in cardiomyocytes caused by donepezil are believed to mediate this effect.
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