Risk of #rhabdomyolysis with #donepezil compared with rivastigmine or galantamine: a population-based cohort study

Donepezil, rivastigmine and galantamine are popular cholinesterase inhibitors used to manage the symptoms of #Alzheimer disease and other dementias; regulatory agencies in several countries warn about a possible risk of rhabdomyolysis..

..The average age in our 2 groups was 81.1 years, and 61.4% of our population was female. Donepezil was associated with a higher risk of hospital admission with rhabdomyolysis compared with rivastigmine or galantamine (88 events in 152 300 patients [0.06%] v. 16 events in 68 053 patients [0.02%]; weighted odds ratio of 2.21, 95% confidence interval [CI] 1.52–3.22). Most hospital admissions with rhabdomyolysis after donepezil use were not severe, and no patient was treated with acute dialysis or mechanical ventilation.

INTERPRETATION: Initiating donepezil is associated with a higher 30-day risk of admission to hospital with rhabdomyolysis compared with initiating rivastigmine or galantamine. The proportion of patients who develop severe rhabdomyolysis within 30 days of initiating donepezil is very low