Safety issues of donepezil combined with memantine in Alzheimer’s disease population: real-world pharmacovigilance

Alzheimer’s disease (AD) is the most common form of dementia. The combination of Donepezil and Memantine is the only FDA-approved therapy for AD, but its adverse drug reactions (ADRs) lack systematic analysis. This study carried out drug combination analysis for AD population to provide evidence support for clinical safety of drug use. Using FAERS database reports (January 2004–January 2024) with Donepezil and Memantine as primary suspected drugs, four disproportionality analysis methods – ROR, PRR, BCPNN, and EBGM – were applied to identify positive ADR signals. Subgroup analyses were conducted by age and gender. A total of 712 reports were analyzed (54.6% female, 55.1% aged 65–85). Across the AD population, 42 ADRs were identified, including hypertensive crisis, hyperglycemia, hyperosmolar nonketotic syndrome, proteinuria, and hydronephrosis, many of which were newly reported. Subgroup analysis revealed prostate hypertrophy, acute kidney injury, and cerebral infarction in males, while females experienced more severe cardiovascular events, such as complete AV block and ventricular extrasystole. Additional ADRs included hyperkalemia, sinus bradycardia, and extrapyramidal disorders. Despite partial consistency of combined ADRs for Donepezil and Memantine with instructions, new ADR signals emerged, with significant differences in AD subgroups.