Safety and tolerability of transdermal and oral rivastigmine in Alzheimer's disease and Parkinson's disease dementia.
BACKGROUND
Cholinesterase inhibitors are the mainstay of symptomatic therapy for Alzheimer's disease (AD). Rivastigmine, an inhibitor of both acetylcholinesterase and butyrylcholinesterase, is available as a transdermal patch and in oral forms. It is also approved for the treatment of Parkinson's disease dementia (PDD) in many countries. The objective of this article is to review the safety and tolerability profile of transdermal and oral rivastigmine in AD and PDD patients.


METHODS
Articles were identified by searching MEDLINE in July 2009 using the terms rivastigmine, Exelon, ENA 713 and clinical trial. All double-blind, placebo-controlled randomized trials in which rivastigmine monotherapy was administered to AD or PDD patients for longer than 2 weeks were included.


RESULTS
This article provides a comprehensive summary of currently available safety data on rivastigmine.


CONCLUSIONS
The main adverse events reported with rivastigmine therapy are gastrointestinal in nature. However, the transdermal patch appears to reduce these side effects, allowing more patients to access higher therapeutic doses. Overall, the safety profile of rivastigmine is favorable and the improved tolerability offered by the rivastigmine patch suggests that transdermal delivery may be the best way to deliver this drug in AD and PDD patients.
Darreh-Shori
Taher
T
Karolinska University Hospital, Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Alzheimer Neurobiology, Novum, 4th Floor, Room 4F23:10, 141 86, Huddinge, Stockholm, Sweden. taher.darreh-shori@ki.se
Jelic
Vesna
V
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D003704:Dementia / Q000150:complications / Q000188:drug therapy*; D017453:Dermatitis, Irritant / Q000517:prevention & control; D006801:Humans; D009325:Nausea / Q000139:chemically induced; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D048448:Phenylcarbamates / Q000008:administration & dosage / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D000068836:Rivastigmine; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D000068836:Rivastigmine