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Whether immediately switching patients from oral donepezil to the rivastigmine transdermal patch or discontinuing donepezil and waiting a week before switching, both strategies appear to be safe and generate no significant deterioration in cognition, behavior, and global functioning in patients with mild-to-moderate Alzheimer's disease (AD).
These findings are from a 25-week randomized trial conducted by Carl H. Sadowsky, M.D., and colleagues, who suggest that the rivastigmine patch offers clinicians another treatment option for patients who need to change their current oral cholinesterase inhibitor (ChEI) therapy due to safety or tolerability issues or lack of therapeutic efficacy. The study results provide overall support for use of the rivastigmine patch in patients with AD for up to 25 weeks.
Sadowsky told The Update: "Patients switching from oral donepezil to the rivastigmine patch will generally tolerate the medication change well." He noted that the most common reason for switching is lack of efficacy, and that "many patients will not respond well to initial ChEI therapy." Another reason for switching to the transdermal patch involves tolerability issues with oral agents, said Sadowsky.
The trial was designed as a prospective, 25-week, randomized, open-label, parallel-group study, comprising a 5-week core phase1 and a 20-week extension phase. The core phase was conducted to assess safety and tolerability of an immediate …