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Cholinergic symptoms with low serum cholinesterase from therapeutic cholinesterase inhibitor toxicity

Published:January 06, 2014DOI:https://doi.org/10.1016/j.ajem.2013.12.048
      Although cholinesterase inhibitors have been frequently used in the treatment of Alzheimer disease, its effects on serum cholinesterase concentrations have been rarely described. We described significant depression of serum cholinesterase levels due to cholinesterase inhibitor toxicity from redundant use of donepezil and rivastigmine in a 78-year-old man. Recovery of serum cholinesterase level was noted upon drug discontinuation and cholinergic symptom resolution. Serum cholinesterase level can be used as a biomarker for central cholinesterase inhibitor toxicity.
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