title: Lack of adverse pharmacodynamic drug interactions with rivastigmine and twenty-two classes of medications.
abstract: Alzheimer's disease (AD) is often associated with multiple comorbidities and subsequent polypharmacy. Treatment of AD with acetylcholinesterase (AChE) inhibitors can carry a risk of drug interaction with multiple medications often prescribed for other co-existing illnesses. Rivastigmine is an AChE inhibitor that is enzymatically cleaved by AChE, minimally metabolized by cytochrome P450 enzymes, has low protein binding, has a short plasma half-life, and a relatively short duration of action. Such properties make it ideal for use in this patient population. A pharmacodynamic analysis of rivastigmine administered concomitantly with other medications (22 different therapeutic classes) did not reveal any significant pattern of increase in adverse events that would indicate a drug interaction. In summary, rivastigmine was well tolerated and safely administered to a population receiving multiple medications for 'real-world' comorbidities.
authors.affiliation: St Louis University Medical Center, 1221 S. Grand Blvd, St Louis, MO 63104, USA.
authors.forename: G T
authors.initials: GT
authors.lastname: Grossberg
authors.forename: H B
authors.initials: HB
authors.lastname: Stahelin
authors.forename: J C
authors.initials: JC
authors.lastname: Messina
authors.forename: R
authors.initials: R
authors.lastname: Anand
authors.forename: J
authors.initials: J
authors.lastname: Veach
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000453:epidemiology; D002219:Carbamates / Q000494:pharmacology* / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D015897:Comorbidity; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D003627:Data Interpretation, Statistical; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D048448:Phenylcarbamates; D019338:Polypharmacy; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D000068836:Rivastigmine
chemical_list: D002219:Carbamates; D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D003577:Cytochrome P-450 Enzyme System; D000068836:Rivastigmine