Domperidone is effective in the prevention of rivastigmine-related gastrointestinal disturbances.
Nausea and/or vomiting are frequent dose-limiting class effects of cholinesterase inhibitors, occurring mostly during the dose-escalation phase. These untoward effects make it difficult to increase rivastigmine dosage above 6 mg daily in most patients. The antiemetic domperidone was given to 22 patients with Alzheimer's disease (9 men, 13 women; mean age 74.5+/-4.6 years; mean age at diagnosis: 73.1+/-5.0 years) in 15-day prophylactic cycles, starting 15 days before each dose escalation of rivastigmine above 6 mg daily. Only four patients (18.2%) experienced nausea, which was so mild that all patients reached >or=9 mg rivastigmine daily and 16 (72.7%) reached and maintained the top dosage (12 mg daily). An improvement or stabilization of Mini Mental State Examination scores was achieved in 54.5% of the patients. The treatment regimen was well tolerated; no patients stopped treatment because of adverse events. Further investigations assessing the role of domperidone in the prevention of rivastigmine-related gastrointestinal disturbances are warranted.
Scarzella
Leonardo
L
Department of Neurology, Evangelico Valdese Hospital, Turin, Italy. neurologia.oev@asl1.to.it
Costanza
Alessandra
A
Vastola
Katia
K
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000188:drug therapy; D000932:Antiemetics / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D004294:Domperidone / Q000627:therapeutic use*; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D048448:Phenylcarbamates / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D000068836:Rivastigmine
D000932:Antiemetics; D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D004294:Domperidone; D000068836:Rivastigmine