- Short-term risk for rhabdomyolysis hospitalization was more than twice as high among older adults initiating donepezil (Aricept) vs rivastigmine (Exelon) or galantamine (Razadyne).
Why this matters
- Emergence of this risk during postmarketing surveillance, but uncertainty about its incidence and severity.
- Compared with rivastigmine or galantamine, donepezil conferred higher 30-day risk for hospital admission with rhabdomyolysis:
- Incidence: 0.06% vs 0.02%.
- Weighted OR: 2.21 (95% CI, 1.52-3.22).
- Donepezil-associated hospital admissions:
- 12-day median length of stay.
- 10% of patients admitted to ICU.
- None treated with acute dialysis, mechanical ventilation.
- Baseline statin use did not modify the observed association between donepezil and risk for hospital admission with rhabdomyolysis.
- Canadian population-based retrospective cohort study 2002-2017 among 220,353 adults aged >65 years with a newly dispensed prescription for donepezil, rivastigmine, or galantamine.
- Main outcome: hospital admission with rhabdomyolysis (from diagnostic codes) within 30 days of prescription.
- Funding: Institute for Clinical Evaluative Sciences (ICES).
- Reliance on administrative data.
- Inability to accurately capture falls (also a cause of rhabdomyolysis).
- Exclusion of younger patients, patients prescribed doses outside those routinely recommended.
- Grouping of rivastigmine and galantamine.