Anesthesia: ARICEPT®, as a cholinesterase
inhibitor, is likely to exaggerate succinylcholine-type muscle relaxation during
anesthesia.
Cardiovascular Conditions: Because of their pharmacological action,
cholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular
nodes. This effect may manifest as bradycardia or heart block in patients both with
and without known underlying cardiac conduction abnormalities. Syncopal episodes
have been reported in association with the use of ARICEPT®.
Gastrointestinal Conditions: Through their primary action, cholinesterase
inhibitors may be expected to increase gastric acid secretion due to increased cholinergic
activity. Therefore, patients should be monitored closely for symptoms of active
or occult gastrointestinal bleeding, especially those at increased risk for developing
ulcers, e.g., those with a history of ulcer disease or those receiving concurrent
nonsteroidal anti-inflammatory drugs (NSAIDS). Clinical studies of ARICEPT®
have shown no increase, relative to placebo, in the incidence of either peptic ulcer
disease or gastrointestinal bleeding.
ARICEPT®, as a predictable consequence of its pharmacological
properties, has been shown to produce diarrhea, nausea and vomiting. These effects,
when they occur, appear more frequently with the 10 mg/day dose than with the 5
mg/day dose. In most cases, these effects have been mild and transient, sometimes
lasting one to three weeks, and have resolved during continued use of ARICEPT®.
Genitourinary: Although not observed in clinical trials of ARICEPT®,
cholinomimetics may cause bladder outflow obstruction.
Neurological Conditions: Seizures: Cholinomimetics are believed to
have some potential to cause generalized convulsions. However, seizure activity
also may be a manifestation of Alzheimer's Disease.
Pulmonary Conditions: Because of their cholinomimetic actions, cholinesterase
inhibitors should be prescribed with care to patients with a history of asthma or
obstructive pulmonary disease.