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.
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.
Authors: S M Greenberg; M K Tennis; L B Brown; T Gomez-Isla; D L Hayden; D A Schoenfeld; K L Walsh; C Corwin; K R Daffner; P Friedman; M E Meadows; R A Sperling; J H Growdon Journal: Arch Neurol Date: 2000-01
Authors: N R Cutler; R J Polinsky; J J Sramek; A Enz; S S Jhee; L Mancione; J Hourani; P Zolnouni Journal: Acta Neurol Scand Date: 1998-04 Impact factor: 3.209
Authors: R M Nitsch; S Rossner; C Albrecht; M Mayhaus; J Enderich; R Schliebs; M Wegner; T Arendt; H von der Kammer Journal: J Physiol Paris Date: 1998 Jun-Aug
Authors: Gary S Figiel; Carl H Sadowsky; John Strigas; Barbara Koumaras; Xiangyi Meng; Ibrahim Gunay Journal: Prim Care Companion J Clin Psychiatry Date: 2008
Authors: Hyun Jeong Han; Jeong Ju Lee; Sun A Park; Hyun Young Park; Jeong Eun Kim; Young Soo Shim; Dong-Seok Shim; Eun-Joo Kim; Soo Jin Yoon; Seong Hye Choi Journal: J Clin Neurol Date: 2011-09-29 Impact factor: 3.077