Switching From Donepezil to Rivastigmine Is Well Tolerated

Abstract

Background: Transitioning patients between cholinesterase inhibitors was thought to require a washout period to avoid cholinergic toxicity; however, evidence suggests that abrupt discontinuation of donepezil may lead to cognitive decline. We evaluated the safety and tolerability of an immediate switch from donepezil to rivastigmine.Method: This is an analysis of the safety and tolerability data from the first 28 days of an open-label, multicenter, prospective trial, conducted from August 2002 to August 2003, in which patients satisfying NINCDS-ADRDA criteria for probable Alzheimer's disease were administered rivastigmine 1.5 mg b.i.d. within 24 to 36 hours of donepezil discontinuation. Results are compared with adverse event rates from a retrospective analysis of a pivotal, placebo-controlled trial examining patients not previously treated with a cholinesterase inhibitor.Results: Fifty-eight of 61 patients completed the first 28 days, with no suspected drug-related discontinuations during this period. Incidence of overall gastrointestinal adverse events at day 7 was 8.2%, and at day 28 was 11.5%. The corresponding rate for rivastigmine-treated patients in the retrospective analysis of the pivotal trial for day 7 was 3.3%.Conclusion: These study results suggest that transitioning patients from donepezil to rivastigmine without a washout period is safe and well tolerated.

Efficacy and Safety of Switching from Oral Cholinesterase Inhibitors to the Rivastigmine Transdermal Patch in Patients with Probable Alzheimer's Disease

“…The results of this study concur with those of previous clinical trials conducted in patients who were switched from donepezil to rivastigmine. 12 , 19 , 20 In an open-label clinical trial, patients were switched from donepezil to rivastigmine due to a lack of efficacy (55%) or adverse events (45%), and nearly half of them demonstrated improvement in cognition while receiving rivastigmine treatment. 12 …”

Bistable perception, precision and neuromodulation

“…Specifically, to study the cholinergic neurotransmission, one can administer the drug donepezil, as in Sheynin et al. (2020) , or rivastigmine that also reduces ACh levels ( Sadowsky et al. 2005 ).…”

Strategies for Continued Successful Treatment in Patients with Alzheimer’s Disease: An Overview of Switching Between Pharmacological Agents

“…A post-hoc analysis of data from three clinical trials [ 41 , 44 , 58 ] conducted by Sadowsky CH et al compared the tolerability of switching from donepezil to the rivastigmine patch (4.6 mg/24h) or rivastigmine capsules (3-12 mg/day). Results from this analysis indicate better tolerability of the rivastigmine patch versus rivastigmine capsules; there were fewer gastrointestinal AEs (nausea: 3.8% versus 32.9%; vomiting: 4.2% versus 24.1%, respectively) and discontinuations due to AEs (14.6% versus 19.3%, respectively) with the patch [ 57 ].…”

“…Results from this analysis indicate better tolerability of the rivastigmine patch versus rivastigmine capsules; there were fewer gastrointestinal AEs (nausea: 3.8% versus 32.9%; vomiting: 4.2% versus 24.1%, respectively) and discontinuations due to AEs (14.6% versus 19.3%, respectively) with the patch [ 57 ]. Evidence from an open-label study suggests that switching patients from donepezil to rivastigmine without a washout period is well tolerated [ 58 ]. In a more recent observational, retrospective, multicenter study conducted in patients with AD (N=1022), improved ease of administration (56.65%), tolerability (36.79%), efficacy (31.60%), and adherence (18.59%) were the main reasons for switching to the rivastigmine patch from any oral ChEI [ 59 ].…”