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Dementia Patients Tolerate Switch From Oral Donepezil to Rivastigmine Patch: Presented at ICAD

By Ed Susman

CHICAGO -- July 29, 2008 -- Switching patients from the oral acetylcholinesterase inhibitor donepezil to the rivastigmine patch can be achieved with minimal adverse effects, according to research presented here at the 2008 International Conference on Alzheimer's Disease (ICAD).

"A noticeable cognitive improvement was reported by caregivers in 30% of patients after 2 months of treatment with the [rivastigmine] patch," said Joshua R. Shua-Haim, MD, Jersey Shore University Medical Center, Neptune, New Jersey.

Dr. Shua-Haim and colleagues enroled 56 patients diagnosed with Alzheimer's disease over a 3-month period.

"Patients were weaned from donepezil using a 2-step regimen. Patients who were treated with donepezil 10 mg daily had their dose reduced to 5 mg daily and were also given the option of adding the rivastigmine patch at 4.6 mg daily in the morning for 1 month," Dr. Shua-Haim said in a poster presentation on July 28.

After 1 month, donepezil treatment was stopped and rivastigmine patch dose was increased to 9.5 mg a day.

After 2 months, 7 patients reported tiredness or sleepiness with the patch while 3 patients developed a patch-related skin rash.

In addition, 17 patients (30.3%) showed cognitive improvement, according to their caregivers' assessments after 2 months of treatment.

No adverse events were reported during the first step of the trial, and 44% of patients appeared to have an improvement in cognition during that first month, also according to their caregivers' assessments.

Patients who elected to use the patch had been on donepezil for an average of 2.4 years. "Those patients who were on donepezil for less than 1 year were advised not to switch to the patch," Dr. Shua-Haim said.

Patients who had improved while using donepezil therapy were also advised not to switch treatment.

"Two-step crossover from donepezil to rivastigmine patch was well tolerated," said Dr. Shua-Haim.


[Presentation title: Results of a Two-Step Crossover Study of Donepezil (Aricept) to Rivastigmine Patch (Exelon Patch) in Alzheimer's Disease Patients: A Two-Month Clinical Experience. Poster P2-409]

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