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Title: Immediate Switch From Donepezil Tablets to Rivastigmine Patch Well Tolerated: Presented at ANA
URL: http://www.pslgroup.com/dg/22D74E.htm
Doctor's Guide
September 24, 2008

By Andrew N. Wilner, MD

SALT LAKE CITY, Utah -- September 24, 2008 -- Patients with Alzheimer's disease can switch from donepezil tablets to the rivastigmine transdermal patch immediately without suffering anticholinergic or other side effects, according to research presented here at the American Neurological Association (ANA) 133rd Annual Meeting.

Lead author Gus Alva, MD, ATP Clinical Research, Inc, Costa Mesa, California, and colleagues undertook a prospective, 5-week, open-label, parallel-group study comparing the effects of an immediate switch from donepezil tablets to the rivastigmine 4.6 mg/day transdermal patch or a delayed switch after a 7-day withdrawal period.

Donepezil has a half-life of 70 hours, which raised the concern that an immediate switch to another medication with anticholinergic properties might cause transient anticholinergic toxicity, Dr. Alva explained.

Patients in both groups had been taking donepezil for a median of 24 months. Just over half the patients in both groups were also taking memantine, which was continued during the study. The groups were evenly matched as to gender, age, and mean dementia duration.

More than 90% of the patients completed the trial in each group. Eleven patients discontinued the study in the immediate-switch group compared to 10 in the delayed group.

Thirty-six of 131 patients in the immediate-switch group had adverse effects compared with 45 of 130 patients in the delayed-switch group.

The incidence of adverse events was less than 5% in both groups, and included agitation, application-site reaction, bradycardia, constipation, decreased appetite, hallucination, nausea, and somnolence. Six patients had application-site reactions from the rivastigmine patch, 1 in the immediate-switch group and 5 in the delayed-switch group.

Mean body weight was stable in both groups.

The researchers concluded that "these results suggest that one can stop donepezil and apply the rivastigmine patch the next day without concern for increasing anticholinergic side effects."

As for efficacy, the Clinical Global Impression of Change scores were 3.9 in the immediate-switch group and 4 in the delayed-switch group, which was not statistically meaningful.

Funding for this study was supported by Novartis Pharmaceuticals Corporation.


[Presentation title: SWAP: Safety and Tolerability of Switching Oral Donepezil to Rivastigmine Patch in Alzheimer's Disease. Abstract T-20]

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