Dementia drugs: Understanding common side effects and how they may affect the heart

Newspapers are often full of headlines about dementia. Recently some of them have written articles about whether or not dementia drugs might cause heart problems.

What do we mean by 'dementia drugs'?

Dementia is the broad term used to describe a number of different conditions affecting the brain.

There is currently no cure for the diseases that cause dementia.

However, some drugs can help to relieve or control symptoms for people living with Alzheimer’s disease, dementia with Lewy bodies or Parkinson’s disease dementia.

Unfortunately, there are currently no drugs that can improve the cognitive symptoms of vascular dementia or frontotemporal dementia.

What drugs are available to treat the cognitive symptoms of dementia?

The main drugs used to treat cognitive symptoms of dementia are called ‘cholinesterase inhibitors’.

Cholinesterase inhibitors include donepezil, rivastigmine and galantamine. There is also a drug called memantine, which works slightly differently.

These drugs don’t work for everyone, and the average effect is fairly small. But, for most people, they’re still well worth trying.

What are the common side effects of dementia drugs?

While many people can take dementia drugs without any problems, some may experience unpleasant side effects. The most common side effects include:

  • nausea, vomiting, diarrhoea
  • loss of appetite
  • muscle pain
  • sleep problems
  • feeling tired
  • headaches
  • itching or a rash
  • dizziness or feeling faint
  • hallucinations
  • agitation or aggression

If you experience any of these symptoms while you are taking drugs for dementia, you should contact your GP as soon as possible. Your GP may be able to offer an alternative treatment that is easier for you to take.

Dementia drugs and heart problems: what does the latest research say?

The effect of dementia drugs on the health of a person’s heart and blood vessels appears to be generally quite positive.

A recent review of studies found that people who took cholinesterase inhibitors had a 37 per cent lower risk of having a heart attack or stroke.

The research study found that these people were also less likely to die from a heart-related problem.

However, the review also found an increased risk of a relatively rare problem called ‘bradycardia’.

What is bradycardia?

Bradycardia is when the heart beats too slowly. This can prevent enough blood from being pumped up to the brain, leaving the person feeling dizzy and breathless. This increases the risk of falling and sustaining a hip fracture, which is a really serious problem for older people in particular.

Because of the risks of falling, doctors often recommend that people with a very slow heart beat have a pacemaker fitted. This keeps the heart beating fast and regular enough to get a good supply of blood to the brain.

These issues are why your doctor is likely to check whether you have a pre-existing heart problem before prescribing these drugs.

So, the good news is that bradycardia is generally quite rare. Even though dementia drugs may increase the risk of having a slow heartbeat, the overall chances of developing this problem are still very low.

By contrast, heart attacks and strokes are quite common in older people, and dementia drugs like donepezil seem to reduce the risk of these happening.

It is very important to discuss any side effects you may be experiencing with your GP – particularly if these include feeling dizzy or faint. Your GP will be able to check your heart beat and assess the potential risks and benefits of continuing with your current medication. Keep taking your medication in the meantime, unless advised by a clinician to stop.

For support

  • If you are seeking support or advice, our advisers are here for you. Call the National Dementia Helpline on 0300 222 1122. 
  • We also have a Live Online Advice service available Monday to Friday (9am–12pm) and Monday to Wednesday (6pm-8pm).
  • Visit our online community, Talking Point, and share your experiences with other people affected by dementia.
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3 comments

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My spouse has been on Denepozil since 2013 and it is quite helpful -sorry about spelling-he does have some of the symptoms, dizziness, slow heart rate, sometimes nausea but in general, doing quite well. Would like to know info about Namenda which he takes at the same time. Also has Mesothelioma in rt lung, chemo caused blood clot in left lung has limited time and no more help for the cancer.

Due to extreme stress, I must correct my previous email to you. My spouse takes the EXELON PATCH every day with NAMENDA. He was diagnosed in 2014 but has begun in 2011 with symptoms. I am questioning if these are helping to slow it down. I do believe they are. He also takes CBD pills, Turmeric, Mangosteen juice, Astragalus Tea pills, Algal 900 mg of DHA and vitamins, etc. Also dealing with Mesothelioma and blood clot in his left lung. He will be on hospice care in a matter of time as they cannot treat him anymore. He can be very witty when playing dominoes or a card game but doesn't remember if he ate his lunch which is kind of funny (I told him I can skip preparing a meal if I feel like it 'cause you don't know if you ate!) I would appreciate any advice or just an opinion of what's good or bad.

Hi Joyce, I am so sorry to hear of your spouse’s condition. Mesothelioma is a horrible disease which is hard for anyone to go through, let alone a person with dementia who may struggle to understand their situation. Sadly it is all too common for someone with dementia to develop some form of cancer.

It sounds like your spouse is being well cared for. However, they do seem to be taking quite a lot of pills, particularly over-the-counter supplements. While there is unlikely to be any harm in this, it might be worth thinking about limiting their ‘pill burden’ if taking pills by mouth is becoming difficult – particularly the swallowing part. You can discuss this with your spouse’s doctor who should be able to advise further on the relative benefits of continuing with these.

Towards the end of life, it can sometimes be useful to review the prescription medications that a person is taking, so they only end up taking the ones that are providing real and immediate benefits. For a person with dementia, this can include reviewing the drugs they are taking to boost cognitive function.

Recent guidance from the National Institute for Health and Clinical Excellence (NICE) recommends that rivastigmine (Exelon) and memantine (Namenda) can be taken together in both the moderate and severe stages of Alzheimer’s disease (and also in some other types of dementia). NICE also recommends that these drugs should not be stopped just because a person is in the later stages of dementia (when it’s very difficult to know whether or not they’re working). This recommendation comes from a recent trial that compared quality of life in some people who were asked to stop taking these types of drugs versus others who were asked to keep taking them. The trial found that the people who stopped taking their anti-dementia medication had slightly worse symptoms than those who stayed on their medication. So, on average, it may be better to keep taking these drugs unless they are causing serious side effects or drug interactions. Again, this is something you can discuss in more detail with your spouse’s doctor.

In case you haven’t already come across these, you may find some of the information in these factsheets about end of life care useful. They cover many of the same issues, but from from their own particular perspectives:

End of life: a guide. A booklet for people in the final stages of life, and their carers’
https://be.macmillan.org.uk/Downloads/CancerInformation/EndOfLife/MAC14…

Alzheimer’s Society factsheet: End of life care (contains useful information on physical needs, including eating and drinking and pain)
https://www.alzheimers.org.uk/sites/default/files/2018-10/531LP%20End%2…

British Lung Foundation: End of life with mesothelioma
https://www.blf.org.uk/support-for-you/mesothelioma/support/end-of-life

You can also always call the Alzheimer’s Society helpline if you need to speak to someone about dementia-related problems, or the Macmillan Cancer Support helpline if you need more cancer-related advice:

Alzheimer’s Society National Dementia helpline: 0300 222 11 22
Monday to Wednesday 9am – 8pm
Thursday and Friday 9am – 5pm
Saturday and Sunday 10am – 4pm

Macmillan helpline: 0808 808 00 00
Monday to Friday, 9am – 8pm

I hope this helps.

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