A Review of the First Transdermal Treatment for Alzheimer’s Disease – The Rivastigmine Patch

A Review of the First Transdermal Treatment for Alzheimer’s Disease – The Rivastigmine Patch

Frölich Lutz

Lutz Frölich

European Psychiatric Review 2008;1(1):33-5

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Currently, cholinesterase inhibitors are the mainstay in clinical practice of symptomatic treatment for Alzheimer’s disease (AD). They are believed to act by inhibiting one or both of the enzymes that degrade acetylcholine in the synaptic cleft, i.e. acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), thereby putatively improving neuronal transmission.1 An association of AChE and BuChE with the underlying AD pathology has also been reported;2,3 however, the long-term clinical impact of these effects, and of targeting one versus both of these enzymes, is still being elucidated. 1,4

Currently, cholinesterase inhibitors are the mainstay in clinical practice of symptomatic treatment for Alzheimer’s disease (AD). They are believed to act by inhibiting one or both of the enzymes that degrade acetylcholine in the synaptic cleft, i.e. acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), thereby putatively improving neuronal transmission.1 An association of AChE and BuChE with the underlying AD pathology has also been reported;2,3 however, the long-term clinical impact of these effects, and of targeting one versus both of these enzymes, is still being elucidated.1,4

Currently, there are three cholinesterase inhibitors widely used to treat AD patients: rivastigmine, donepezil and galantamine. Rivastigmine provides sustained inhibition of AChE and BuChE, while donepezil and galantamine are selective AChE inhibitors.5 In 2005, rivastigmine became the first approved treatment for mild to moderate Parkinson’s disease dementia (PDD). All cholinesterase inhibitors have been available in oral formulations. Recently, a transdermal rivastigmine patch has been developed, and is approved in many countries worldwide (including the US, Latin America, Europe and Asia) for the treatment of AD. The rivastigmine patch has also been approved for the treatment of PDD in the US, Latin America and Asia.

A transdermal drug delivery system has the potential to change the treatment paradigm for many AD patients.6 This article reviews the clinical and pharmacokinetic data that supported the development of the rivastigmine patch, and discusses the ways in which the use of a transdermal patch may improve the management of dementia patients in a real-life setting.

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