Rivastigmine Transdermal Patch
▴ 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.
- 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.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
- 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.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.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.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]
- 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
- 17.Exelon® 4.6 and 9.5 mg/24 hours trandermal patch: summary of product characteristics. Horsham: Novartis Europharm Limited, 2007.Google Scholar
- 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]
- 28.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington,DC: American Psychiatric Association, 1994Google Scholar
- 30.Data on file, Novartis Europharm Ltd, 2007Google Scholar