What are side effects of acetylcholinesterase inhibitors used for dementia?

Sarah N. Mourra, MD
In terms of important side effects from acetylcholinesterase inhibitors in people with dementia, the main thing to consider is that all of these medications have adverse effects in terms of loss of appetite, nausea or gastrointestinal (GI) symptoms like diarrhea. When people are started on these medications they may begin losing their appetite. For people who may be more nonverbal, this may manifest as more irritability, refusing meals and mood changes. It’s important to be aware of the timing of these medications and to monitor your loved one or elder’s eating habits and schedule following initiation of these medications.
Oftentimes, rivastigmine (Exelon) is the worst offender when it comes to the GI side effects, which is one reason why the patch form of this drug is helpful. The patch form does not have the risk of GI side effects like the oral form does.
The second major thing to look out for with acetylcholinesterase inhibitors is that they can lower the heart rate. What this means is that for individuals who may already have a low heart rate, the medication may lower their heart rate further, putting them at risk for passing out or falling from decreased blood flow to the brain. Therefore, it’s important to monitor your elder or loved one for dizziness or falling after starting these medications and to monitor his or her heart rate. Because of this risk, doctors will typically not start one of these medications unless the heart rate is above 60 beats per minute.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.