Donepezil, a cholinesterase inhibitor, can worsen bradycardia and heart block due to increased parasympathetic activity, posing risks in patients with pre-existing cardiac conduction abnormalities.
Contraindicated in sick sinus syndrome or supraventricular conduction abnormalities without pacemaker.
Elderly patients are at higher risk due to age-related conduction changes.
Baseline ECG recommended before starting therapy.
Report symptoms like dizziness or fainting immediately.
Donepezil inhibits acetylcholinesterase, elevating acetylcholine levels in the synaptic cleft. This enhances vagal tone on the heart, slowing sinoatrial node firing and potentially impairing atrioventricular conduction, exacerbating bradycardia or heart block.
Increased risk of symptomatic bradycardia, atrioventricular block progression, syncope, hypotension, or rare cardiac arrest; symptoms may include dizziness, fatigue, or palpitations.
Use with caution or avoid in patients with uncontrolled bradycardia or conduction defects; monitor heart rate and ECG closely; initiate at lowest dose and titrate slowly; consider pacemaker placement for severe cases; discontinue if significant bradycardia develops.
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