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Switch from Donepezil to Rivastigmine Well Tolerated in Elderly Patients with Alzheimer's Disease: Presented at AGS

By Anne Jacobson
Special to DG News

WASHINGTON, DC -- May 15, 2002 -- Elderly patients with Alzheimer's disease who switched from donepezil to rivastigmine without a washout period appear to remain at or above baseline status in neuropsychological and neurobehavioral assessments.

"Based on our experience, switching Alzheimer's disease patients from donepezil to rivastigmine is well tolerated," said Gustavo J. Rey, PhD, of the University of Miami in Miami, Florida, United States. Dr. Rey and his team reported their research findings here Friday at the annual scientific meeting of the American Geriatrics Society.

Donepezil and rivastigmine are new generation acetylcholinesterase inhibitors with improved safety profiles. Because there are no reported studies documenting clinical findings in Alzheimer's disease patients switched from donepezil to rivastigmine, Dr. Rey and colleagues designed a study to closely monitor the clinical and neurobehavioral status of patients making the switch.

For this study Dr. Rey focused on Alzheimer's disease patients receiving donepezil and experiencing symptoms of neurocognitive or behavioral decline according to their caregivers. In total, 16 patients were identified and switched to rivastigmine.

In these patients, rivastigmine was initiated at 1.5 mg BID for two weeks without washout from donepezil. Over the study period, rivastigmine was gradually increased to 6 mg BID. Patients were evaluated at baseline, one and three months after the stitch and assessed with an assortment of cognitive and behavioral instruments. Adverse events were also recorded.

Four (25 percent) patients experienced mild to marked improvement in their Folstein MMSE scores. Three of these patients also experienced marked clinical improvement in verbal learning and fluency.

Overall, repeated measure analysis revealed no clinically significant changes in any of the neuropsychological measures, BEHAVE-AD, and caregiver's quality of life scores.

Adverse events reported were typical of acetylcholinesterase inhibitors. At the first visit, adverse events included gastrointestinal complaints (19 percent) and dizziness (9 percent). Similar adverse events were noted while the patients were receiving donepezil.

With dose adjustments, adverse events diminished significantly by the final visit. Rivastigmine was discontinued in one patient.

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