Can Alzheimer’s Disease or Its Medications Cause Heart Palpitations, and When Is Urgent Care Needed?

Heart palpitations can occur in people with Alzheimer’s disease, most commonly as a side effect of certain Alzheimer’s medications rather than the disease itself. Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) can slow the heart rate and, in susceptible individuals, lead to irregular rhythms that may feel like fluttering, pounding, or skipped beats. ^[1] These drugs have been associated with bradycardia (slow heart rate), syncope (fainting), and occasionally other rhythm problems. ^[2] Memantine is generally tolerated but rare reports include bradycardia and changes in blood pressure, which can be perceived as palpitations. ^[3]

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How Alzheimer’s Medications Can Affect the Heart

• Cholinesterase inhibitors (ChEIs): donepezil, rivastigmine, galantamine

  • These medicines increase acetylcholine, which can have a “vagotonic” effect on the heart’s pacemaker and conduction nodes. This can manifest as bradycardia or heart block, and some individuals may experience irregular heartbeats or fainting. ^[2] Clinical guidance notes that people with certain heart conditions may be at risk for irregular heartbeat while on these medications. ^[1]
  • Population studies and reviews suggest a small but significant increase in syncope and bradycardia with ChEIs; rare cases of QT prolongation and torsades de pointes have been reported. ^[3] Hospitalizations for bradycardia have been observed particularly within the first few months of therapy. ^[4]

• Memantine (NMDA receptor antagonist)

  • Generally well tolerated, but there have been reports of bradycardia and reduced cardiovascular survival in some observational data, so caution is reasonable in at‑risk patients. ^[3]

• Donepezil product information

  • Official labeling warns of vagotonic effects that can cause bradycardia, heart block, and syncope; palpitations may accompany these conduction changes. ^[2] Adverse event listings include supraventricular tachycardia and other cardiovascular events, highlighting that rhythm symptoms can occur. ^[5]

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Table: Cardiac Considerations of Common Alzheimer’s Medications

Medication	Typical Use	Noted Cardiac Concerns	Practical Notes
Donepezil	All stages	Vagotonic effects → bradycardia, heart block, syncope; rare SVT/QT issues	Monitor pulse; caution with pre‑existing conduction disease or on other rate‑slowing drugs. [2] [3] [5]
Rivastigmine	Mild–moderate	Similar class effects (bradycardia/syncope potential)	Patch may reduce GI side effects; cardiac vigilance similar to other ChEIs. [3]
Galantamine	Mild–moderate	Similar class effects (bradycardia/syncope potential)	Start low, titrate; assess for baseline heart disease. [3]
Memantine	Moderate–severe	Rare reports of bradycardia and BP changes	Generally better tolerated; still monitor symptoms if new palpitations. [3]
Anti‑amyloid agents (e.g., donanemab)	Selected cases	Can cause BP changes and shortness of breath (not routine palpitations)	Requires specialized monitoring; discuss risks individually. [6]

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When to Seek Urgent Medical Evaluation

Most palpitations are benign, but urgent evaluation is needed if palpitations occur with red‑flag symptoms:

• Chest pain or discomfort. ^{[7] [8]}
• Shortness of breath. ^{[7] [8]}
• Fainting or near‑fainting, severe dizziness, or marked weakness. ^{[7] [8]}
• A very fast or irregular pulse with feeling unwell. ^[9]

These combinations can signal dangerous arrhythmias or other heart problems and should prompt immediate medical care (emergency services). Even without red flags, frequent or worsening palpitations especially in someone with known heart disease warrant timely clinical assessment and possibly heart monitoring tests. ^[7]

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Practical Steps if Palpitations Start After an Alzheimer’s Medication

• Check pulse and blood pressure if you can, and note timing relative to doses or recent dose increases. Early months of ChEIs are a period of higher bradycardia risk, so new palpitations then deserve attention. ^[4]
• Contact your clinician to review all medications, including over‑the‑counter drugs and supplements that might affect heart rhythm or slow heart rate (for example, beta‑blockers). A 12‑lead ECG is an essential first test to screen for conduction problems or arrhythmia. ^[10]
• Consider ambulatory monitoring if palpitations are intermittent; event/loop monitors are often more useful than a 24‑hour Holter when episodes are infrequent. ^[10] This helps distinguish benign extrasystoles from atrial fibrillation or other arrhythmias. ^[10]
• Do not stop Alzheimer’s medication abruptly without medical advice, but dose adjustment, switching agents, or addressing interacting drugs may be recommended after evaluation. ^[3] In those with existing heart disease, more careful monitoring is advised when starting or increasing ChEIs. ^[11]

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Key Takeaways

• Alzheimer’s medications, particularly cholinesterase inhibitors, can contribute to palpitations through bradycardia and conduction effects; memantine has rarer cardiac reports. ^{[1] [2] [3]}
• Seek emergency care for palpitations with chest pain, shortness of breath, fainting, severe dizziness, or feeling acutely unwell. ^{[7] [8] [9]}
• Arrange prompt medical review for new, frequent, or worsening palpitations, especially soon after starting or increasing Alzheimer’s medications or in the presence of known heart disease. ^{[4] [10]}

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