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Switching from Donepezil Tablets to Rivastigmine Transdermal Patch in Alzheimer's Disease

Premiere Research Institute, Palm Beach Neurology, West Palm Beach, Florida, CHsadow{at}aol.com, Nova SE University, Fort Lauderdale, Florida

Alan Dengiz, MD

St Joseph Mercy Health System, Ann Arbor, Michigan

Jason T. Olin, PhD

Novartis Pharmaceuticals Corporation, East Hanover, New Jersey

Barbara Koumaras, BA

Novartis Pharmaceuticals Corporation, East Hanover, New Jersey

Xiangyi Meng, PhD

Novartis Pharmaceuticals Corporation, East Hanover, New Jersey

Stephen Brannan, MD

Takeda Pharmaceuticals North America, Deerfield, Illinois

US38 study group

Objective: Evaluate safety and tolerability of switching from donepezil to rivastigmine transdermal patch in patients with mild to moderate Alzheimer's disease. Methods: Prospective, parallel-group, open-label study to evaluate immediate or delayed switch from 5-10 mg/day donepezil to 4.6 mg/24 h rivastigmine following a 4-week treatment period. Results: Rates of discontinuation due to any reason or adverse events were similar between groups. Incidences of gastrointestinal adverse events were 3.8% in the immediate and 0.8% in the delayed switch group. No patients discontinued secondary to nausea and vomiting. Discontinuations due to application site reactions were low (2.3%). Asymptomatic bradycardia was more common following the immediate switch (2.3% vs 0%); however, these patients had coexisting cardiac comorbidities. Conclusion: Both switch strategies were safe and well tolerated. The majority of patients may be able to switch directly to rivastigmine patches without a withdrawal period. Appropriate clinical judgment should be used for patients with existing bradycardia or receiving β blockers.

Key Words: Alzheimer's disease • clinical trial • donepezil • rivastigmine • switching • transdermal patch

This version was published on June 1, 2009

American Journal of Alzheimer's Disease and Other Dementias®, Vol. 24, No. 3, 267-275 (2009)
DOI: 10.1177/1533317509333037


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