Potential cardiotoxic reaction involving rivastigmine and beta-blockers: a case report and review of the literature.

Abstract

We report a case of potential cardiovascular toxicity including syncope, bradycardia, and ECG pauses associated with the use of rivastigmine and atenolol. A 65-year-old African American female with a medical history of dementia, hypertension, seizure disorder, stroke, and peripheral vascular disease was admitted to the hospital with shortness of breath and syncope. She was witnessed to have experienced a presyncopal episode followed by a true syncopal episode in which she was unresponsive for 20-30 s. On day two of hospital stay, the patient's ECG showed a sinus bradycardia with a heart rate in the 40 s and sinus pauses greater than 2 s in duration. Atenolol was immediately discontinued, with a continuance of the bradycardia despite one missed dose. The potentially toxic combination of rivastigmine and atenolol was then identified as a plausible causative factor of this patient's syncope and was subsequently discontinued. This patient's Naranjo adverse reaction probability score was five, which indicates a probable association between syncope and bradycardia with the combination of rivastigmine and atenolol [13]. Following the discontinuation of rivastigmine, the ECG pauses resolved and the patient's heart rate returned to normal levels. The patient did not experience any further dizziness or syncope. A 65-year-old female developed syncope and subsequent ECG pauses with sinus bradycardia after being treated with rivastigmine for dementia. Atenolol may have further compounded this toxic effect by its pharmacodynamic mechanisms.

• Authors: Barbara Paulison, Cara L Léos
• Journal: Cardiovascular toxicology (Cardiovasc Toxicol) Vol. 10 Issue 4 Pg. 306-10 (Dec 2010) ISSN: 1559-0259 [Electronic] United States
• PMID: 20865460 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Adrenergic beta-Antagonists
• Cholinesterase Inhibitors
• Phenylcarbamates
• Atenolol
• Rivastigmine

Topics

• Adrenergic beta-Antagonists (adverse effects)
• Aged
• Atenolol (adverse effects)
• Bradycardia (chemically induced, diagnosis, physiopathology)
• Cholinesterase Inhibitors (adverse effects)
• Drug Interactions
• Dyspnea (chemically induced)
• Electrocardiography
• Female
• Heart Rate (drug effects)
• Humans
• Phenylcarbamates (adverse effects)
• Rivastigmine
• Syncope (chemically induced)