A case of rivastigmine toxicity caused by transdermal patch

Lee, Dong Hoon; Choi, Yoon Hee; Cho, Kwang Hyun; Yun, Soon Young; Lee, Hyung Min

doi:10.1016/j.ajem.2010.05.024

Cited by 14 publications

(6 citation statements)

References 7 publications

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“…Currently, there are disadvantages associated with current Alzheimer’s disease chemotherapeutics. For example, tacrine was observed to have serious side effects such as elevated liver transaminases and gastrointestinal problems [ 10 , 11 ]; donepezil has been reported to exhibit toxicity similar to beta-blocker overdose and colitis [ 12 ]; the toxicity of rivastigmine is thought to be similar to that of other carbamates and organophosphates with features of muscarinic and nicotinic stimulation [ 13 ]. Essential oils and their chemical constituents have been shown to have effects on the central nervous system, including in the treatment of Alzheimer’s disease and Parkinson’s disease [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Acetylcholinesterase Inhibitory Activities of Essential Oils from Vietnamese Traditional Medicinal Plants

et al. 2022

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Essential oils are promising as environmentally friendly and safe sources of pesticides for human use. Furthermore, they are also of interest as aromatherapeutic agents in the treatment of Alzheimer’s disease, and inhibition of the enzyme acetylcholinesterase (AChE) has been evaluated as an important mechanism. The essential oils of some species in the genera Callicarpa, Premna, Vitex and Karomia of the family Lamiaceae were evaluated for inhibition of electric eel AChE using the Ellman method. The essential oils of Callicarpa candicans showed promising activity, with IC50 values between 45.67 and 58.38 μg/mL. The essential oils of Callicarpa sinuata, Callicarpa petelotii, Callicarpa nudiflora, Callicarpa erioclona and Vitex ajugifolia showed good activity with IC50 values between 28.71 and 54.69 μg/mL. The essential oils Vitex trifolia subsp. trifolia and Callicarpa rubella showed modest activity, with IC50 values of 81.34 and 89.38, respectively. trans-Carveol showed an IC50 value of 102.88 µg/mL. Molecular docking and molecular dynamics simulation were performed on the major components of the studied essential oils to investigate the possible mechanisms of action of potential inhibitors. The results obtained suggest that these essential oils may be used to control mosquito vectors that transmit pathogenic viruses or to support the treatment of Alzheimer’s disease.

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Section: Introductionmentioning

confidence: 99%

Acetylcholinesterase Inhibitory Activities of Essential Oils from Vietnamese Traditional Medicinal Plants

et al. 2022

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“…Serum ChE should be periodically measured in patients with cholinesterase inhibitors to avoid lifethreatening adverse effects. [3] 150/80 106 87 M ND [21] 169/119 88 38 M 947 U/g hemoglobin (range, 2710-11510 U/g) [22] 180/90 79 59 M 6.0 μkat/L (range, 60-190 μkat/L) [23] 186/61 83 91 F 35 [24] 207/85 101 80 F ND [25] Vital signs and serum cholinesterase (ChE) upon initial presentation are summarized for patients A (distigmine) and B (rivastigmine) BP blood pressure, PR pulse rate, ND not determined *Reference article did not include the reference range…”

Section: Resultsmentioning

confidence: 99%

“…A nationwide database study showed that the iatrogenic cholinergic crisis is a rare but potentially life-threatening condition in Japan [1]. The clinical features resemble carbamate and organophosphate poisoning with symptoms that include both muscarinic (e.g., salivation, lacrimation, urination, defecation, miosis, bronchorrhea, and bradycardia) and nicotinic (e.g., muscle weakness, fasciculations, and paralysis) stimulation [2,3]. Here, we present 2 cases of cholinergic crisis caused by the reversible cholinesterase inhibitors; distigmine and rivastigmine focused on changes in blood pressure (BP) and pulse rate (PR).…”

Section: Introductionmentioning

confidence: 99%

Opposite changes in blood pressure and pulse rate in two patients with distigmine and rivastigmine intoxication

Sedogawa

Matsuo

2020

JA Clin Rep

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Background: Cholinergic crisis caused by cholinesterase inhibitors is rare but life-threatening. Clinical manifestations are thought to be similar to those caused by organophosphates. Case presentation: A 77-year-old woman on a standard dose of distigmine presented with impaired consciousness, blood pressure (BP) of 69/40 mmHg, a pulse rate (PR) of 60 beats/min, miosis, bronchorrhea, and serum cholinesterase (ChE) of 8 IU/L. After discontinuation of distigmine, altered mental status and pupil miosis were gradually resolved in 5 days with a concomitant increase of serum ChE. A 91-year-old woman presented with a headache, BP of 202/86 mmHg, PR of 83 beats/min, miosis, 9 rivastigmine patches on her knees, and ChE of 22 IU/L. The day after close observation without rivastigmine use, her symptoms were almost resolved with a concomitant increase of serum ChE. Conclusion: Our cases and a literature review suggested that, in contrast to distigmine, rivastigmine-induced cholinergic crisis caused hypertension and tachycardia.

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“…There are several prior reports of toxicity from rivastigmine patches in adults but none in pediatric patients. 16,18 Theoretically, these patches could pose a risk similar to those described with transdermal fentanyl or clonidine. 19,20 However, only 3 cases were reported in our study, and none reported any symptoms.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Pediatric Exposures to Antidementia Drugs Reported to a Poison Control System

Thornton

Pchelnikova

Cantrell

2016

The Journal of Pediatrics

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A case of rivastigmine toxicity caused by transdermal patch

Cited by 14 publications

References 7 publications

Acetylcholinesterase Inhibitory Activities of Essential Oils from Vietnamese Traditional Medicinal Plants

Acetylcholinesterase Inhibitory Activities of Essential Oils from Vietnamese Traditional Medicinal Plants

Opposite changes in blood pressure and pulse rate in two patients with distigmine and rivastigmine intoxication

Characteristics of Pediatric Exposures to Antidementia Drugs Reported to a Poison Control System

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