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drug adverse effects of cholinesterase inhibitors

Adverse effects: 1) miosis 2) increased tone of skeletal & intestinal musculature - muscle spasms, leg cramps - diarrhea, bloat 3) constriction of bronchi 4) constriction of ureters, detrusor urinary frequency, urinary incontinence (2%) 5) bradycardia, HR=1.69 6) stimulation of secretion by salivary glands & sweat glands 6) syncope, HR=1.76 [1,2] 7) higher rates of permanent pacemaker insertion, HR=1.49 8) falls - hip fracture HR= 1.18 - deprescribing cholinesterase inhibitors in nursing home residents associated with lower risks for serious falls & fractures [5] - in patients with cognitive impairment, cholinesterase inhibitors reduce risk of falls [9] 9) confusion 10) insomnia [4], abnormal dreams 11) unintentional weight loss (10-pound weight loss over 12 months) in demented patients: 29% vs 23% (placebo); NNH = 21 [3,7,8] - anorexia Notes: - deprescribing cholinesterase inhibitors may result in worse cognitive, neuropsychiatric & functional status vs continuing treatment but certainty is low to very low [6] - deprescribing cholinesterase inhibitors in nursing home residents with advanced dementia not associated with negative outcomes [5]

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GENERAL: drug adverse effect(s) of DRUGS: cholinesterase inhibitor FORM: drug adverse effects cholinesterase inhibitor

References

  1. Gill SS et al, Syncope and Its Consequences in Patients With Dementia Receiving Cholinesterase Inhibitors Arch Intern Med. 2009;169(9):867-873 PMID: 19433698
  2. Kim DH, Brown RT, Ding EL, et al. Dementia medications and risk of falls, syncope, and related adverse events: meta-analysis of randomized controlled trials. J Am Geriatr Soc 2011; 59:1019-1031 PMID: 21649634
  3. Sheffrin M et al. Weight loss associated with cholinesterase inhibitors in individuals with dementia in a national healthcare system. J Am Geriatr Soc 2015 Aug; 63:1512 PMID: 26234945
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, 18 American College of Physicians, Philadelphia 2015, 2018
  5. Niznik JD, Zhao X, He M et al. Risk for health events after deprescribing acetylcholinesterase inhibitors in nursing home residents with severe dementia. J Am Geriatr Soc 2020 Apr; 68:699-707 PMID: 31769507 https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16241
  6. Parsons C, Lim WY, Loy C et al Withdrawal or continuation of cholinesterase inhibitors or memantine or both, in people with dementia. Cochrane Database of Systematic Reviews. 2021. Feb 3. Not indexed in PubMed https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009081.pub2/full
  7. Soysal P, Isik AT, Stubbs B et al. Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2016 Dec;87(12):1368-1374 PMID: 27261502 https://jnnp.bmj.com/content/87/12/1368
  8. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  9. Ahuja M, Siddhpuria S, Karimi A et al. Cholinesterase inhibitors and falls, syncope and injuries in patients with cognitive impairment: a systematic review and meta-analysis. Age Ageing. 2023 Nov 2;52(11):afad205 PMID: 37993407