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Pharmacokinetic rationale for the rivastigmine patch

From the University of California-Los Angeles Alzheimer’s Center, Los Angeles, California (Prof. Cummings), Novartis Pharma AG, Exploratory Development, Basel, Switzerland (Drs. Lefèvre and Appel-Dingemanse), and Semel Institute for Neuroscience and Human Behavior at University of California-Los Angeles, California (Prof. Small).

Address correspondence and reprint requests to Prof. Jeffrey Cummings, UCLA Alzheimer’s Center, 10911 Weyburn Ave., 2nd Floor, Los Angeles, CA 90095-7226 jcummings{at}mednet.ucla.edu

The dual cholinesterase inhibitor rivastigmine is approved in capsule form in many countries for the symptomatic treatment of dementia associated with Alzheimer disease (AD) and Parkinson disease (PD). All orally administered cholinesterase inhibitors are associated with central cholinergic gastrointestinal side effects, particularly during the titration phase, which are believed to be caused by a rapid increase in brain acetylcholine levels after effective inhibition of the target enzymes. A recently developed rivastigmine transdermal patch may have the potential to reduce such side effects. Pharmacokinetic studies have shown that transdermal administration of rivastigmine prolongs t_max, lowers C_max, and reduces fluctuations in plasma concentration. The 10-cm² rivastigmine patch provides comparable exposure (area under the curve, AUC) to the highest capsule dose (6-mg BID) and may be the target maintenance dose for most patients, delivering optimal rivastigmine exposure to produce a therapeutic effect. The potential of a patch to improve the tolerability of rivastigmine (e.g., nausea and vomiting) while permitting similar exposure to the highest doses of capsules may, in turn, lead to improved efficacy and compliance.

Disclosure: Prof. Cummings has received honoraria during his career (in excess of $10,000) from the sponsor. The sponsor has provided Prof. Small with honoraria (in excess of $10,000) during his career. Dr. Lefèvre is an employee of the sponsor. Dr. Appel-Dingemanse is an employee of the sponsor and has equity or ownership interest. This supplement has been made possible by an educational grant by Novartis Pharma AG, Basel, Switzerland.

Neurology® supplements are not peer-reviewed. Information contained in Neurology® supplements represents the opinions of the authors and is not endorsed by nor does it reflect the views of the American Academy of Neurology, Editorial Board, Editor-in-Chief, or Associate Editors of Neurology®.

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				W. Oertel, J. S. Ross, K. Eggert, and G. Adler Rationale for transdermal drug administration in Alzheimer disease Neurology, July 24, 2007; 69(4_suppl_1): S4 - S9. [Abstract] [Full Text] [PDF]