Switching from donepezil to rivastigmine is well tolerated: Results of an open-label safety and tolerability study

Carl H. Sadowsky, Martin R. Farlow, Leone Atkinson, Jennifer Steadman, Barbara Koumaras, Michael Chen, Dario Mirski

Research output: Contribution to journalArticle

20 Scopus citations


Background: Transitioning patients between cholinesterase inhibitors was thought to require a washout period to avoid cholinergic toxicity; however, evidence suggests that abrupt discontinuation of donepezil may lead to cognitive decline. We evaluated the safety and tolerability of an immediate switch from donepezil to rivastigmine. Method: This is an analysis of the safety and tolerability data from the first 28 days of an open-label, multicenter, prospective trial, conducted from August 2002 to August 2003, in which patients satisfying NINCDS-ADRDA criteria for probable Alzheimer's disease were administered rivastigmine 1.5 mg b.i.d. within 24 to 36 hours of donepezil discontinuation. Results are compared with adverse event rates from a retrospective analysis of a pivotal, placebo-controlled trial examining patients not previously treated with a cholinesterase inhibitor. Results: Fifty-eight of 61 patients completed the first 28 days, with no suspected drug-related discontinuations during this period. Incidence of overall gastrointestinal adverse events at day 7 was 8.2%, and at day 28 was 11.5%. The corresponding rate for rivastigmine-treated patients in the retrospective analysis of the pivotal trial for day 7 was 3.3%. Conclusion: These study results suggest that transitioning patients from donepezil to rivastigmine without a washout period is safe and well tolerated.

Original languageEnglish (US)
Pages (from-to)43-48
Number of pages6
JournalPrimary Care Companion to the Journal of Clinical Psychiatry
Issue number2
StatePublished - Jan 1 2005

ASJC Scopus subject areas

  • Psychiatry and Mental health

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