Skip to main content
SpringerLink
Log in

Transdermal Rivastigmine

Management of Cutaneous Adverse Events and Review of the Literature

  • Therapy in Practice
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

Alzheimer’s disease is a chronic neurodegenerative disorder resulting in part from the degeneration of cholinergic neurons in the brain. Rivastigmine, a cholinesterase inhibitor, is commonly used as a treatment for dementia due to its ability to moderate cholinergic neurotransmission; however, treatment with oral rivastigmine can lead to gastrointestinal adverse effects such as nausea and vomiting. Transdermal administration of rivastigmine can minimize these adverse effects by providing continuous delivery of the medication, while maintaining the effectiveness of the oral treatment. While the transdermal form of rivastigmine has been found to have fewer systemic adverse effects compared with the oral form, cutaneous reactions, such as contact dermatitis, can lead to discontinuation of the drug in its transdermal form. Lack of patient compliance with regard to applying the patch to the designated site, applying the patch for the correct length of time or rotating patch application sites increases the risk of cutaneous adverse reactions. This article outlines the diagnosis and management of irritant contact dermatitis and allergic contact dermatitis secondary to transdermal rivastigmine.

The large majority of reactions to transdermal patches are of an irritant type, which can be diagnosed clinically by the presence of a pruritic, erythematous, eczematous plaque strictly confined to the borders of the patch. In contrast, an allergic reaction can be differentiated by the presence of vesicles and/or oedema, erythema beyond the boundaries of the transdermal patch and lack of improvement of the lesion 48 hours after removal of the offending treatment. By encouraging the patient to follow a regular rotation schedule for the patch, and using lipid-based emollients for irritant dermatitis and pre- and post-treatment topical corticosteroids for allergic dermatitis, cutaneous reactions can often be alleviated and patients can continue with their medication regimen. Other simple changes to a patient’s treatment routine, including minimizing the use of harsh soaps, avoiding recently shaven or damaged areas of skin and carefully removing the patch after use, can help to further decrease the risk of dermatitis development.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig 2
Fig 3

Similar content being viewed by others

References

  1. Davies P, Maloney AJ. Selective loss of central cholinergic neurons in Alzheimer’s disease [letter]. Lancet 1976; 2: 1403

    Article  PubMed  CAS  Google Scholar 

  2. Weinstock M. Selectivity of cholinesterase inhibition: clinical implications for the treatment of Alzheimer’s disease. CNS Drugs 1999; 12: 307–23

    Article  CAS  Google Scholar 

  3. Eisai Co. FDA accepts Aricept Patch (donepezil transdermal system) NDA for review [media release]. 2010 Sep 17 [online]. Available from URL: http://www.eisai.com/news/enews201049pdf [Accessed 2011 May 11]

  4. Corey-Bloom J, Anand R, Veach J. A randomized trial evaluating the efficacy and safety of ENA 713 (rivastigmine tartrate), a new acetylcholinesterase inhibitor, in patients with mild to moderately severe Alzheimer’s disease. Int J Geriatr Psychopharmacol 1998; 1: 55–65

    CAS  Google Scholar 

  5. Schneider LS, Anand R, Farlow MR. Systematic review of the efficacy of rivastigmine for patients with Alzheimer’s disease. Int J Geriatr Psychopharmacol 1998; 1: S26–34

    CAS  Google Scholar 

  6. Inglis F. The tolerability and safety of cholinesterase inhibitors in the treatment of dementia. Int J Clin Pract Suppl 2002; (127): 45-63

  7. Winblad B, Grossberg B, Frolich L, et al. IDEAL: a 6-month, double-blind, placebo-controlled study of the first skin patch for Alzheimer disease. Neurology 2007; 69: 14–22

    Article  Google Scholar 

  8. Lefèvre G, Sedek G, Jhee S, 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 2008; 83: 106–14

    Article  PubMed  Google Scholar 

  9. Zhai H, Maibach HI, editors. Dermatotoxicology. 6th ed. New York (NY): CRC Press LLC, 2004

    Google Scholar 

  10. Grossberg GT, Sadowsky S, Olin JT. Rivastigmine transdermal system for the treatment of mild to moderate Alzheimer’s disease. Int J Clin Pract 2010; 64: 534–6

    Article  Google Scholar 

  11. 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; 22: 485–91

    Article  PubMed  Google Scholar 

  12. Bernabei R, Martínez Lage P. Clinical benefits associated with a transdermal patch for dementia. Eur Neurol Rev 2008; 3: 10–3

    Google Scholar 

  13. Exelon® Patch (rivastigmine transdermal system): full prescribing information [online]. East Hanover (NJ): Novartis Pharmaceuticals Corporation, 2010. Available from URL: http://www.pharma.us.novartis.com/product/pi/pdf/exelonpatch.pdf [Accessed 2011 May 11]

  14. Ale I, Lachapelle JM, Maibach HI. Skin tolerability associated with transdermal drug delivery systems: an overview. Adv Ther 2009; 26: 920–35

    Article  PubMed  CAS  Google Scholar 

  15. Widman TJ, Oostman H, Storrs FJ. Allergic contact dermatitis from medical adhesive bandages in patients who report having a reaction to medical bandages. Dermatitis 2008; 19: 32–7

    PubMed  Google Scholar 

  16. Sadowsky C, Dengiz A, Olin J, et al. Switching from done-zepil tablets to rivastigmine transdermal patch in Alzheimer’s disease. Am J Alz Dis Other Demen 2009; 24: 267–75

    Article  Google Scholar 

  17. Beltrani VS, Beltrani VP. Contact dermatitis. Ann Allergy Asthma Immunol 1997; 78: 160–73

    Article  PubMed  CAS  Google Scholar 

  18. Saary J, Qureshi R, Palda V, et al. A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol 2005; 53: 845

    Article  PubMed  Google Scholar 

  19. Usatine RP, Riojas M. Diagnosis and management of contact dermatitis. Am Fam Physician 2010; 82: 249–55

    PubMed  Google Scholar 

  20. Zeller S, Warshaw E. Allergic contact dermatitis. Minn Med 2004; 87: 38–42

    PubMed  Google Scholar 

  21. Loden M. Barrier recovery and influence of irritant stimuli in skin treated with a moisturizing cream. Contact Dermatitis 1997; 36: 256–60

    Article  PubMed  CAS  Google Scholar 

  22. Loden M, Andersson AC. Effect of topically applied lipids on surfactant-irritated skin. Br J Dermatol 1996; 134: 215–20

    Article  PubMed  CAS  Google Scholar 

  23. Queille-Roussel C, Duteil L, Padilla JM, et al. Efficacy of topical corticosteroids in nickel-induced contact allergy. Clin Exp Dermatol 2002; 27: 47–50

    Article  Google Scholar 

  24. Levin C, Zhai H, Bashir S, et al. Efficacy of corticosteroids in acute experimental irritant contact dermatitis. Skin Res Technol 2001; 7: 214–8

    Article  PubMed  CAS  Google Scholar 

  25. Zhai H, Brachman F, Pelosi A, et al. A bioengineering study on the efficacy of a skin protectant lotion in preventing SLS-induced dermatitis. Skin Res Technol 2000; 6: 77–80

    Article  PubMed  Google Scholar 

  26. Perrenoud D, Gallezot D, van Melle G. The efficacy of a protective cream in a real-world apprentice hairdresser environment. Contact Dermatitis 2001; 45: 134–8

    Article  PubMed  CAS  Google Scholar 

  27. Amkraut AA, Jordan WP, Taskovich I. Effect of coadministration of corticosteroids on the development of contact sensitization. J Am Acad Dermatol 1996; 35: 27–31

    Article  PubMed  CAS  Google Scholar 

  28. Gupta AK, Chow M. Pimecrolimus: a review. J Eur Acad Dermatol Venereol 2003; 17: 493–503

    Article  PubMed  CAS  Google Scholar 

  29. Berardesca E, Barbareschi M, Veraldi S, et al. Evaluation of efficacy of a skin lipid mixture in patients with irritant contact dermatitis, allergic contact dermatitis or atopic dermatitis: a multicenter study. Contact Dermatitis 2001; 45: 280–5

    Article  PubMed  CAS  Google Scholar 

  30. Berman B, France DS, Martinelli GP, et al. Modulation of expression of epidermal Langerhans cell properties following in situ exposure to glucocorticosteroids. J Invest Dermatol 1983; 80: 168–71

    Article  PubMed  CAS  Google Scholar 

  31. Toews GB, Bergstreser PR, Streilein JW. Epidermal Langerhans cell density determines whether contact hyper-sensitivity or unresponsiveness follows skin painting with DNFB. J Immunol 1980; 124: 445–53

    PubMed  CAS  Google Scholar 

  32. Lefevre G, Sedek G, Huang HL, et al. Pharmacokinetics of a rivastigmine transdermal patch formulation in healthy volunteers: relative effects of body site application. J Clin Pharmacol 2007; 47: 471–8

    Article  PubMed  CAS  Google Scholar 

  33. Arnold LE, Lindsay RL, Lopez FA, et al. Treating attention-deficit/hyperactivity disorder with a stimulant transdermal patch: the clinical art. Pediatrics 2007; 120: 1100–6

    Article  PubMed  Google Scholar 

  34. Health Canada. Drugs and health products [online]. Available from URL: http://hc-sc.gc.ca/dhp-mps/medeff/advisories-avis/prof/_2010/exelon_hpc-cps-eng.php [Accessed 2011 May 10]

Download references

Acknowledgements

No funding was provided to prepare this review. Dr Nathan Herrmann has received speaker’s honoraria from Novartis (maker of the Exelon® Patch). He also received honoraria, research support and/or consultant fees from Lundbeck, Janssen-Ortho, Pfizer, Wyeth and Sonexa. Neither Dr David Adam nor Jill Greenspoon has any conflicts of interest to report.

Author information

Authors and Affiliations

  1. Faculty of Medicine, University of Western Ontario, Schulich School of Medicine and Dentistry, 520 Talbot Street — Unit 412, London, ON, N6A6K4, Canada

    Jill Greenspoon

  2. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Nathan Herrmann

  3. Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Nathan Herrmann

  4. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    David N. Adam

  5. St. Michael’s Hospital, Toronto, ON, Canada

    David N. Adam

Authors
  1. Jill Greenspoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathan Herrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David N. Adam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jill Greenspoon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Greenspoon, J., Herrmann, N. & Adam, D.N. Transdermal Rivastigmine. CNS Drugs 25, 575–583 (2011). https://doi.org/10.2165/11592230-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11592230-000000000-00000

Keywords

Search

Navigation