What transdermal medication is used for dementia?

From the Guidelines

Transdermal rivastigmine, specifically the Exelon patch, is the most effective and recommended transdermal medication for treating mild to moderate Alzheimer's disease and Parkinson's disease dementia, as it provides steady drug levels and reduces gastrointestinal side effects. The Exelon patch is typically started at 4.6 mg/24 hours (5 cm²) for at least four weeks, then increased to 9.5 mg/24 hours (10 cm²) if tolerated, as supported by the study 1. Some key points to consider when prescribing transdermal rivastigmine include:

• The patch should be applied once daily to clean, dry, hairless skin on the upper or lower back, upper arm, or chest, rotating application sites to minimize skin irritation.
• Rivastigmine works by inhibiting acetylcholinesterase, which increases acetylcholine levels in the brain to improve cognitive function, as noted in the study 1.
• Common side effects include skin irritation at the application site, sleep disturbances, and decreased appetite, but these are generally milder than with oral formulations. The study 1 highlights the importance of considering the limitations of available studies, including short duration and limited evaluation of behavior and quality-of-life outcomes, when making treatment decisions. However, the Exelon patch has been shown to result in statistically significant but clinically marginal improvement in measures of cognition and global assessment of dementia, making it a valuable treatment option for patients with dementia.

From the FDA Drug Label

1.1 Alzheimer's Disease 1.2 Parkinson’s Disease Dementia 2.1 Dosing in Alzheimer’s Disease 2.2 Dosing in Parkinson’s Disease Dementia

• Rivastigmine (TD) is a transdermal medication used for the treatment of:
  • Alzheimer's Disease
  • Parkinson’s Disease Dementia The medication rivastigmine (TD) is used to treat dementia, specifically Alzheimer's Disease and Parkinson’s Disease Dementia 2.

From the Research

Transdermal Medication for Dementia

• Transdermal patches, such as rivastigmine, are a convenient treatment option for patients with Alzheimer's disease-associated dementia 3, 4, 5.
• Rivastigmine transdermal patches have been shown to be effective in improving cognitive and global function in patients with mild to moderate dementia of the Alzheimer's type 3, 4, 6, 7.
• The patches have a favorable tolerability profile, with most adverse events being mild to moderate in severity, and are generally better tolerated than oral rivastigmine, especially in terms of cholinergic gastrointestinal adverse events 3, 4, 6, 7.

Efficacy and Safety

• High-dose rivastigmine (6 to 12 mg daily) has been associated with statistically significant benefits on cognitive function and activities of daily living, although the effects are small and of uncertain clinical importance 6, 7.
• The transdermal patch may have fewer side effects than the capsules, but has comparable efficacy 6, 7.
• Patient Reminder Cards (PRCs) have been shown to be effective in preventing incorrect patch use and improving adherence to treatment 5.

Dose Titration and Administration

• The majority of patients requiring dose-change were up-titrated to 9.5 mg/day patches, with a mean duration of 58 days 5.
• The use of PRCs, including a Medication record sheet, has been shown to be helpful in preventing incorrect patch use and improving adherence to treatment 5.