Some Dementia Meds May Cause Serious Weight Loss

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Cholinesterase inhibitors, a class of medication commonly used in the treatment of dementia, may lead to extreme weight loss in some instances.

Drugs in this category include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon).

Meera Sheffrin, MD, geriatrics fellow in the University of California, San Francisco School of Medicine and with the San Francisco VA Medical Center, examined national VA data from 2007-2010 to evaluate patients 65 and older diagnosed with dementia who received a new prescription for a cholinesterase inhibitor or other new chronic medication.

A total of 1,188 patients started on cholinesterase inhibitors were matched to 2,189 patients started on other medications. At 12 months, 78% were still on the inhibitors, compared to 66% for other medications. And, about 29.3% of patients on the inhibitors experienced significant weight loss, compared to 22.8% of non-users, the researchers reported in Journal of the American Geriatrics Society.

The results indicate that patients started on the cholinesterase inhibitors had a higher risk of clinically significant weight loss over a 12-month period compared to control. Put another way, one out of every 21 patients treated experienced at least a 10-pound weight loss.

“This is very relevant to patient care because unintentional weight loss in older adults is associated with many adverse outcomes, including increased rates of institutionalization and mortality, a decline in functional status, and poorer quality of life,” Sheffrin said in a statement.

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Dementia patients on cholinesterase inhibitors had a higher risk of significant weight loss compared to those not on the drugs.

Medications commonly used to treat dementia could result in harmful weight loss, according to University of California, San Francisco researchers, and clinicians need to account for this risk when prescribing these drugs to older adults, they said.

Alzheimer's disease and other dementias are prevalent, affecting one in six people over age 80. The main drug treatments, a class of medications called cholinesterase inhibitors (i.e., donepezil, galantamine, rivastigmine), are marginally beneficial for most patients and may have serious side effects such as gastrointestinal symptoms.

Weight loss also is a significant problem in dementia patients and linked to increased mortality. Data from randomized controlled trials suggests this weight loss may be an under-recognized side effect of cholinesterase inhibitors, but evidence is limited and conflicting.

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