Противодементные лекарственные средства и синдром удлиненного интервала QT

Abstract

Listen

Translate article

Aim. Analysis and systematization of the results of domestic and foreign studies of drug-induced QT prolongation and the risk of Torsade de Pointes (TdP) associated with the use of antidementia drugs to update the knowledge of practicing neurologists about the possibility of predicting and preventing life-threatening cardiac adverse drug reactions. Key points. Dementia is a syndrome that accompanies various neurodegenerative diseases, which causes significant maladjustment and disability in the patient. Anti-dementia drugs are used to slow down the progression of dementia which require long-term (lifelong) appointment. Therefore, the safety profile of these drugs is important in practice, in particular such conditions as the long QT syndrome and the development of ventricular tachycardia (TdP). The authors searched for full-text domestic and foreign publications (full-text versions of original articles, clinical cases, systematic reviews, meta-analyses, Cochrane reviews) in Russian and English, available in knowledge-intensive bibliographic databases (eLIBRARY, PubMed, Scopus, Springer, ClinicalKeys, OxfordPress, Google Scholar, MedCredit, DrugBank, PharmGKB), by keywords and their combinations. The study was conducted in accordance with the requirements for the PRISMA 2022 systematic review. The search depth is 10 years (2013–2023). Conclusion. The systematic review demonstrated the variable effect of antidementia drugs on the processes of repolarization and depolarization of the ventricular myocardium: shortening of the QT interval, no effect, borderline prolongation of the QT interval, prolongation of the QT interval. Donepezil has the lowest cardiac safety profile. Studies of galantamine have yielded conflicting results. The lowest risk of QT prolongation and TdP development was observed with rivastigmine and memantine. There is insufficient data on the cardiac safety of the new generation of antidementia drugs: aducanumab, lecanemab and donanemab. Keywords: antidementia drugs, adverse drug reactions, dementia, prolongation of the QT interval, cardiotoxicity, long QT syndrome, Torsade de Pointes, ventricular tachycardia, sudden cardiac death.