Switching from donepezil tablets to rivastigmine transdermal patch in Alzheimer's disease.
OBJECTIVE
Evaluate safety and tolerability of switching from donepezil to rivastigmine transdermal patch in patients with mild to moderate Alzheimer's disease.


METHODS
Prospective, parallel-group, open-label study to evaluate immediate or delayed switch from 5-10 mg/day donepezil to 4.6 mg/24 h rivastigmine following a 4-week treatment period.


RESULTS
Rates of discontinuation due to any reason or adverse events were similar between groups. Incidences of gastrointestinal adverse events were 3.8% in the immediate and 0.8% in the delayed switch group. No patients discontinued secondary to nausea and vomiting. Discontinuations due to application site reactions were low (2.3%). Asymptomatic bradycardia was more common following the immediate switch (2.3% vs 0%); however, these patients had coexisting cardiac comorbidities.


CONCLUSIONS
Both switch strategies were safe and well tolerated. The majority of patients may be able to switch directly to rivastigmine patches without a withdrawal period. Appropriate clinical judgment should be used for patients with existing bradycardia or receiving beta blockers.
Sadowsky
Carl H
CH
Nova SE University, Fort Lauderdale, Florida, USA. CHsadow@aol.com
Dengiz
Alan
A
Olin
Jason T
JT
Koumaras
Barbara
B
Meng
Xiangyi
X
Brannan
Stephen
S
D000279:Administration, Cutaneous; D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy*; D001066:Appetite; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003248:Constipation / Q000453:epidemiology; D000077265:Donepezil; D004334:Drug Administration Schedule; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D008297:Male; D009325:Nausea / Q000453:epidemiology; D048448:Phenylcarbamates / Q000627:therapeutic use*; D010880:Piperidines / Q000627:therapeutic use; D011446:Prospective Studies; D000068836:Rivastigmine; D013997:Time Factors
D002800:Cholinesterase Inhibitors; D007189:Indans; D048448:Phenylcarbamates; D010880:Piperidines; D000077265:Donepezil; D000068836:Rivastigmine