Which cholinesterase inhibitor is the safest for the heart in elderly patients with Alzheimer's disease?

Objective: Cholinesterase inhibitors (ChEIs) are widely used for the treatment of Alzheimer's disease (AD); however, their cholinergic side effects on the cardiovascular system are still unclear. In this study, we aimed to examine the side effects caused by donepezil, rivastigmine, and galantamine on cardiac rhythm and postural blood pressure changes in elderly patients with AD.

Methods: Of 204 consecutive elderly patients who were newly diagnosed with AD, 162 were enrolled and underwent comprehensive geriatric assessments. The electrocardiographs (ECGs) and blood pressures were recorded at the baseline and 4 weeks after the dose of 10 mg/d of donepezil, 10 cm(2)/d of rivastigmine, and 24 mg/d of galantamine.

Results: There were no changes relative to the baseline in any of the ECG parameters or arterial blood pressure with any of the administered ChEIs.

Conclusion: It was demonstrated that none of the 3 ChEIs were associated with increased negative chronotropic, arrhythmogenic, and hypotensive effects for the elderly patients with AD.