What is the use of Rivastigmine (Rivastigmine)?

From the Guidelines

Rivastigmine is used to treat mild to moderate dementia associated with Alzheimer's disease, Parkinson's disease, and Lewy body dementia, with dosages ranging from 1 mg/d to 12 mg/d, and has been shown to have a statistically significant beneficial effect on cognitive function in some individual trials, although the overall summary effect is highly inconsistent 1. The evidence suggests that rivastigmine has a beneficial effect on cognitive function, particularly in global assessment using the CIBIC-plus, with a statistically significant and clinically important benefit observed in some studies 1. However, the effect on behavior and quality of life is not statistically significant in any study that evaluated these outcomes. Some key points to consider when using rivastigmine include:

• Dosages range from 1 mg/d to 12 mg/d, with some studies evaluating higher doses 1
• The duration of treatment ranges from 14 to 52 weeks, with some studies evaluating longer treatment durations 1
• Common adverse events include gastrointestinal symptoms, eating disorders/weight loss, and dizziness, with a dose-response relationship observed in some studies 1
• Withdrawal rates due to adverse events range from 12% to 29% in the treatment group, compared to 0% to 11% in the placebo group 1

From the FDA Drug Label

Rivastigmine tartrate is an acetylcholinesterase inhibitor indicated for treatment of: • Mild-to-moderate dementia of the Alzheimer's type (AD) • Mild-to-moderate dementia associated with Parkinson's disease (PD)

The use of Rivastigmine is for the treatment of:

• Mild-to-moderate dementia of the Alzheimer's type (AD)
• Mild-to-moderate dementia associated with Parkinson's disease (PD) 2

From the Research

Use of Rivastigmine

• Rivastigmine is a dual cholinesterase inhibitor used for the symptomatic treatment of mild-to-moderate Alzheimer's disease (AD) and Parkinson's disease dementia 3, 4, 5, 6, 7.
• It is also used to treat cognitive and behavioral symptoms in Alzheimer's disease associated with vascular risk factors, dementia with Lewy bodies, and Parkinson's disease dementia 5.
• Rivastigmine has been shown to be beneficial for people with mild to moderate Alzheimer's disease, with improvements seen in cognitive function, activities of daily living, and severity of dementia 4, 5, 6, 7.
• The therapeutic dosing of rivastigmine is 6-12 mg/day, given twice daily, with higher doses having the potential for greater benefits 5.

Administration and Formulation

• Rivastigmine is available in capsule and transdermal patch formulations 3, 4, 6.
• The transdermal patch has been shown to have comparable efficacy to the capsule formulation, with fewer adverse events such as nausea, vomiting, and dizziness 4, 6.
• The smaller transdermal patch (9.5 mg/24 h) has been shown to have fewer adverse events compared to the higher dose patch (17.4 mg/24 h) and the capsule formulation 4, 6.

Adverse Events

• The most common adverse events associated with rivastigmine are gastrointestinal, central and peripheral nervous system, and whole body adverse events 3, 4, 5, 7.
• These adverse events are usually mild to moderate, of short duration, and responsive to dosage reduction 7.
• The incidence of adverse events can be minimized by slower dose-escalation intervals and administration with a full meal 5.