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Rivastigmine Transdermal Patch

A Review of its Use in the Management of Dementia of the Alzheimer’s Type

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Abstract

Rivastigmine, a cholinesterase inhibitor, is available as a transdermal patch (Exelon® patch, Rivastach® patch, Prometax® patch) for the treatment of mild to moderate Alzheimer’s disease. Rivastigmine transdermal patch was effective, in terms of improving cognitive and global function, and generally well tolerated in patients with mild to moderate dementia of the Alzheimer’s type in a large, well designed trial. Most adverse events associated with rivastigmine patch were mild to moderate in severity, with the patch generally better tolerated than oral rivastigmine, especially in terms of cholinergic gastrointestinal adverse events. The patch also had good skin adhesion and a favourable skin tolerability profile in this study, with most application-site reactions being mild in severity. Additionally, in a safety and tolerability study, rivastigmine patch, regardless of concomitant memantine therapy, was generally well tolerated in patients switching from oral donepezil therapy. Thus, current evidence suggests that rivastigmine transdermal patch is an effective treatment option for patients with Alzheimer’s disease, with the potential for improving compliance and providing sustained clinical benefit because of its ease of use and generally favourable tolerability profile.

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    Sohita Dhillon

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Correspondence to Sohita Dhillon.

Additional information

Various sections of the manuscript reviewed by: D. Adamis, Research and Academic Institute of Athens, Athens, Greece; C. Ballard, Wolfson Centre for Age-Related Diseases, King’s College London, London, UK; S. Gauthier, McGill Center for Studies in Aging, Douglas Mental Health Research Institute, Montreal, QC, Canada; J.J. Miguel-Hidalgo, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA; R. Tampi, Yale University School of Medicine, New Haven, CT, USA.

Data Selection

Sources: Medical literature published in any language since 1980 on ‘rivastigmine’, identified using MEDLINE and EMBASE, supplemented by AdisBase (a proprietary database). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.

Search strategy: MEDLINE, EMBASE and AdisBase search terms were ‘rivastigmine’ and (‘Alzheimer disease’ or ‘dementia’). Searches were last updated 10 June 2011.

Selection: Studies in patients with dementia of the Alzheimer’s type who received rivastigmine transdermal patch. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic and pharmacokinetic data are also included.

Index terms: Rivastigmine, cholinesterase inhibitors, Alzheimer’s disease, pharmacodynamics, pharmacokinetics, therapeutic use, tolerability.

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Dhillon, S. Rivastigmine Transdermal Patch. Drugs 71, 1209–1231 (2011). https://doi.org/10.2165/11206380-000000000-00000

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