Skip to main content
The Globe and Mail
Support Quality Journalism
The Globe and Mail
First Access to Latest
Investment News
Collection of curated
e-books and guides
Inform your decisions via
Globe Investor Tools
Just$1.99
per week
for first 24 weeks

Enjoy unlimited digital access
Enjoy Unlimited Digital Access
Get full access to globeandmail.com
Just $1.99 per week for the first 24 weeks
Just $1.99 per week for the first 24 weeks
var select={root:".js-sub-pencil",control:".js-sub-pencil-control",open:"o-sub-pencil--open",closed:"o-sub-pencil--closed"},dom={},allowExpand=!0;function pencilInit(o){var e=arguments.length>1&&void 0!==arguments[1]&&arguments[1];select.root=o,dom.root=document.querySelector(select.root),dom.root&&(dom.control=document.querySelector(select.control),dom.control.addEventListener("click",onToggleClicked),setPanelState(e),window.addEventListener("scroll",onWindowScroll),dom.root.removeAttribute("hidden"))}function isPanelOpen(){return dom.root.classList.contains(select.open)}function setPanelState(o){dom.root.classList[o?"add":"remove"](select.open),dom.root.classList[o?"remove":"add"](select.closed),dom.control.setAttribute("aria-expanded",o)}function onToggleClicked(){var l=!isPanelOpen();setPanelState(l)}function onWindowScroll(){window.requestAnimationFrame(function() {var l=isPanelOpen(),n=0===(document.body.scrollTop||document.documentElement.scrollTop);n||l||!allowExpand?n&&l&&(allowExpand=!0,setPanelState(!1)):(allowExpand=!1,setPanelState(!0))});}pencilInit(".js-sub-pencil",!1); // via darwin-bg var slideIndex = 0; carousel(); function carousel() { var i; var x = document.getElementsByClassName("subs_valueprop"); for (i = 0; i < x.length; i++) { x[i].style.display = "none"; } slideIndex++; if (slideIndex> x.length) { slideIndex = 1; } x[slideIndex - 1].style.display = "block"; setTimeout(carousel, 2500); }

U.S. National Institute on Aging

Two rare but serious side effects have been added to the prescribing information for the Alzheimer's drug donepezil, Health Canada said Wednesday.

The prescription medication has been linked to a muscle breakdown called rhabdomyolysis and the neurological disorder NMS (neuroleptic malignant syndrome) in some patients.

Donepezil, sold under the brand names Aricept and Aricept RDT as well as generic equivalents, is used to treat the symptoms of mild to severe Alzheimer's disease.

Story continues below advertisement

Rhabdomyolysis is a rare condition involving the breakdown of muscle tissue, which can cause serious and sometimes fatal abnormal heart rhythms, kidney damage and kidney failure. However, it is generally treatable if recognized promptly.

NMS is an extremely rare, life-threatening disorder characterized by a chemical imbalance that affects the nervous, muscular and cardiovascular systems. The muscular effects of NMS can sometimes lead to rhabdomyolysis.

"If symptoms of rhabdomyolysis or NMS are noticed, donepezil should be stopped immediately and a doctor or a pharmacist should be contacted right away," Health Canada said in an advisory.

"Symptoms of rhabdomyolysis include a combination of fever, muscle or joint pain, weakness, nausea, and dark (tea-like) urine. Symptoms of NMS include high fever, muscle stiffness or rigidity, mental changes including delirium and agitation, and irregular heartbeat and pulse."

Health Canada said that before prescribing the drug, health professionals should assess patients for risk factors for rhabdomyolysis. They include muscular disorders, uncontrolled hypothyroidism (underactive thyroid) and liver or kidney damage.

The risk could also be increased if a patient is taking another medication known to cause rhabdomyolysis, among them statins to lower cholesterol, antipsychotics, and certain antidepressants known as SSRIs and SNRIs.

The new warnings follow a Health Canada safety review of the drug.

Story continues below advertisement

Rhabdomyolysis and NMS were reported to occur independently with donepezil use. But the muscle disorder may also be a complication of NMS – it was most often reported when donepezil therapy was started or the dose increased.

As of mid-2014, Health Canada had received one report in Canada of rhabdomyolysis possibly related to donepezil, in a patient who recovered. There had been no Canadian cases of NMS reported with the drug.

Internationally, there were 88 cases of rhabdomyolysis and 67 cases of NMS linked with donepezil, with some patients having both conditions. Three deaths were associated with rhabdomyolysis and nine deaths with NMS, most of them in Japan.

Report an error
Due to technical reasons, we have temporarily removed commenting from our articles. We hope to have this fixed soon. Thank you for your patience. If you are looking to give feedback on our new site, please send it along to feedback@globeandmail.com. If you want to write a letter to the editor, please forward to letters@globeandmail.com.

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to letters@globeandmail.com. Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to letters@globeandmail.com. Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff.

We aim to create a safe and valuable space for discussion and debate. That means:

  • Treat others as you wish to be treated
  • Criticize ideas, not people
  • Stay on topic
  • Avoid the use of toxic and offensive language
  • Flag bad behaviour

Comments that violate our community guidelines will be removed.

Read our community guidelines here

Discussion loading ...

To view this site properly, enable cookies in your browser. Read our privacy policy to learn more.
How to enable cookies