CNS Drugs

, Volume 21, Issue 11, pp 957–965 | Cite as

Rivastigmine Transdermal Patch

In the Treatment of Dementia of the Alzheimer’s Type
Adis Drug Profile

Abstract

  • ▴ The cholinesterase inhibitor rivastigmine is now available as a transdermal patch for use in the treatment of mild to moderate dementia of the Alzheimer’s type.

  • ▴ The transdermal patch gradually releases rivastigmine over the application period. There was less fluctuation between plasma peak and trough rivastigmine concentrations with the patch than with the capsule formulation.

  • ▴ The rivastigmine 9.5 mg/24 hours patch was effective in patients with Alzheimer’s disease, according to the results of a well designed, 24-week trial. A significant improvement in Alzheimer’s Disease Assessment Scale —Cognitive subscale (ADAS-Cog) scores and significantly lower Alzheimer’s Disease Cooperative Study —Clinical Global Impression of Change scores were seen with the rivastigmine 9.5 mg/24 hours patch versus placebo.

  • ▴ In addition, treatment with the rivastigmine 9.5 mg/ 24 hours patch was noninferior to rivastigmine 6mg twice-daily capsules, as assessed by ADAS-Cog scores. Significantly more caregivers of study patients preferred administering the patch formulation of rivastigmine than the capsule formulation.

  • ▴ The rivastigmine 9.5 mg/24 hours patch was generally well tolerated by patients with Alzheimer’s disease. The incidence of adverse events (including nausea and vomiting) in the rivastigmine 9.5 mg/ 24 hours patch group was not significantly different to that in the placebo group. However, several adverse events such as nausea and vomiting occurred in significantly more rivastigmine capsule recipients than in placebo recipients.

References

  1. 1.
    Rubin CD. The primary care of Alzheimer disease. Am J Med Sci 2006 Dec; 332(6): 314–33PubMedCrossRefGoogle Scholar
  2. 2.
    Lobo A, Launer LJ, Fratiglioni L, et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000; 54Suppl. 5: S4–9PubMedGoogle Scholar
  3. 3.
    Wimo A, Winblad B, Aguero-Torres H, et al. The magnitude of dementia occurrence in the world. Alzheimer Dis Assoc Disord 2003 Apr–Jun; 17(2): 63–7PubMedCrossRefGoogle Scholar
  4. 4.
    Vas CJ, Rajkumar S, Tanyakitpisal P, et al. Alzheimer’s disease: the brain killer [online]. Available from URL: http://www.searo.who.int/LinkFiles/Health_and_Behaviour_alzheimers.pdf [Accessed 2007 May 17]
  5. 5.
    Fillit H, Cummings J. Practice guidelines for the diagnosis and treatment of Alzheimer’s disease in a managed care setting: part II. Pharmacologic therapy. Alzheimer’s Disease Managed Care Advisory Council. Manag Care Interface 2000 Jan; 13(1): 51–6Google Scholar
  6. 6.
    Jann MW. Rivastigmine, a new-generation cholinesterase inhibitor for the treatment of Alzheimer’s disease. Pharmacotherapy 2000 Jan; 20(1): 1–12PubMedCrossRefGoogle Scholar
  7. 7.
    Plosker GL, Keating GM. Management of mild to moderate Alzheimer disease. Dis Manage Health Outcomes 2004; 12(1): 55–72CrossRefGoogle Scholar
  8. 8.
    Lyketsos CG, Colenda CC, Beck C, et al. Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease. Am J Geriatr Psychiatry 2006 Jul; 14(7): 561–73PubMedCrossRefGoogle Scholar
  9. 9.
    Johannsen P. Long-term cholinesterase inhibitor treatment of Alzheimer’s disease. CNS Drugs 2004; 18(12): 757–68PubMedCrossRefGoogle Scholar
  10. 10.
    Cummings JL, Frank JC, Cherry D, et al. Guidelines for managing Alzheimer’s disease: part II. Treatment. Am Fam Physician 2002 Jun 15; 65(12): 2525–34Google Scholar
  11. 11.
    National Institute for Health and Clinical Excellence. Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer’s disease (amended) [online]. September 2007. Available from URL: http://guidance.nice.org.uk/TAl11/guidance/pdf/English/download.dspx [Accessed 2007 September 27]
  12. 12.
    European Medicines Agency. Exelon® 1.5,3.0, 4.5 and 6.0 hard capsules: summary of product characteristics [online]. Available from URL: http://www.emea.europa.eu/humandocs/PDFs/EPAR/Exelon/H-169-PI-en.pdf [Accessed 2007 May 10]
  13. 13.
    Novartis Pharmaceuticals Corporation. Exelon® (rivastigmine tartrate) capsules and oral solution: US prescribing information [online]. Available from URL: http://www.pharma.us.novartis.com/product/pi/pdf/exelon.pdf [Accessed 2007 May 10]
  14. 14.
    Grossberg GT. Cholinesterase inhibitors for the treatment of Alzheimer’s disease: getting on and staying on. Curr Ther Res 2003 Apr; 64(4): 216–35CrossRefGoogle Scholar
  15. 15.
    Lefèvre G, Sedek G, Jhee SS, et al. Pharmacokinetics and pharmacodynamics of the novel daily rivastigmine transdermal patch compared with twice-daily capsules in Alzheimer’s disease patients. Clin Pharmacol Ther. Epub 2007 May 23Google Scholar
  16. 16.
    Priano L, Gasco MR, Mauro A. Transdermal treatment options for neurological disorders: impact on the elderly. Drugs Aging 2006; 23(5): 357–75PubMedCrossRefGoogle Scholar
  17. 17.
    Exelon® 4.6 and 9.5 mg/24 hours trandermal patch: summary of product characteristics. Horsham: Novartis Europharm Limited, 2007.Google Scholar
  18. 18.
    Novartis Pharmaceuticals Corporation. Exelon® patch (rivastigmine transdermal system): US prescribing information [online]. Available from URL: http://www.pharma.us.novartis.com/product/pi/pdf/exelonpatch.pdf [Accessed 2007 Aug 7]
  19. 19.
    Eskander MF, Nagykery NG, Leung EY, et al. Rivastigmine is a potent inhibitor of acetyl- and butyrylcholinesterase in Alzheimer’s plaques and tangles. Brain Res 2005 Oct 26; 1060(1–2): 144–52PubMedCrossRefGoogle Scholar
  20. 20.
    Muhlack S, Przuntek H, Müller T. Transdermal rivastigmine treatment does not worsen impaired performance of complex motions in patients with Alzheimer’s disease. Pharmacopsychiatry 2006 Jan; 39(1): 16–9PubMedCrossRefGoogle Scholar
  21. 21.
    Darvesh S, Walsh R, Kumar R, et al. Inhibition of human cholinesterases by drugs used to treat Alzheimer disease. Alzheimer Dis Assoc Disord 2003; 17(2): 117–26PubMedCrossRefGoogle Scholar
  22. 22.
    Rakonczay Z. Potencies and selectivities of inhibitors of acetylcholinesterase and its molecular forms in normal and Alzheimer’s disease brain. Acta Biol Hung 2003 Aug; 54(2): 183–9PubMedCrossRefGoogle Scholar
  23. 23.
    Greig NH, Utsuki T, Yu QS, et al. A new therapeutic target in Alzheimer’s disease treatment: attention to butyrylcholinesterase. Curr Med Res Opin 2001; 17(3): 159–65PubMedGoogle Scholar
  24. 24.
    Grossberg GT, Stahelin HB, Messina JC, et al. Lack of adverse pharmacodynamic drug interactions with rivastigmine and twenty-two classes of medications. Int J Geriatr Psychiatry 2000 Mar; 15(3): 242–7PubMedCrossRefGoogle Scholar
  25. 25.
    Lefèvre G, Sedek G, Huang HLA, et al. Pharmacokinetics of a rivastigmine transdermal patch formulation in healthy volunteers: relative effects of body site application. J Clin Pharmacol 2007 Apr; 47(4): 471–8PubMedCrossRefGoogle Scholar
  26. 26.
    Winblad B, Cummings J, Andreasen N, et al. A six-month double-blind, randomized, placebo-controlled study of a trans-dermal patch in Alzheimer’s disease: rivastigmine patch versus capsule. Int J Geriatr Psychiatry 2007 May; 22(5): 456–67PubMedCrossRefGoogle Scholar
  27. 27.
    Winblad B, Kawata AK, Beusterien KM, et al. Caregiver preference for rivastigmine patch relative to capsules for treatment of probable Alzheimer’s disease. Int J Geriatr Psychiatry 2007 May; 22(5): 485–91PubMedCrossRefGoogle Scholar
  28. 28.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington,DC: American Psychiatric Association, 1994Google Scholar
  29. 29.
    Winblad B, Grossberg G, Frolich L, et al. IDEAL: a 6-month, double-blind, placebo-controlled study of the first skin patch for Alzheimer disease. Neurology 2007 Jul 24; 69Suppl. 1: S14–22PubMedCrossRefGoogle Scholar
  30. 30.
    Data on file, Novartis Europharm Ltd, 2007Google Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  1. 1.Wolters Kluwer Health | AdisMairangi Bay, North Shore, AucklandNew Zealand
  2. 2.Wolters Kluwer HealthConshohockenUSA

Personalised recommendations