Rivastigmine side effect by Ray Sahelian, M.D.
February 13 2016

Rivastigmine, a drug prescribed for Alzheimer's dementia, may improve memory in traumatic brain injury patients only in those with severe memory loss. In the overall analysis, rivastigmine was no better than placebo in helping patients improve their memory.

Inhibitors of acetylcholinesterase provide a modest symptomatic benefit for a majority of patients with Alzheimer's disease. Cholinergic "secondary" effects are variable, but sometimes quite invalidating. Nausea and vomiting appear to be linked to peak plasma concentration of the drug. A transdermal patch of rivastigmine is available that allows to obtain a lower peak of concentration, less gastro-intestinal side effects, and an efficacy similar to the oral capsules of rivastigmine.

Review article
Cochrane Database Syst Rev. 2015. Rivastigmine for Alzheimer's disease.B Alzheimer's disease is the commonest cause of dementia affecting older people. One of the therapeutic strategies aimed at ameliorating the clinical manifestations of Alzheimer's disease is to enhance cholinergic neurotransmission in the brain by the use of cholinesterase inhibitors to delay the breakdown of acetylcholine released into synaptic clefts. Tacrine, the first of the cholinesterase inhibitors to undergo extensive trials for this purpose, was associated with significant adverse effects including hepatotoxicity. Other cholinesterase inhibitors, including rivastigmine, with superior properties in terms of specificity of action and lower risk of adverse effects have since been introduced. Rivastigmine has received approval for use in 60 countries including all member states of the European Union and the USA.
   Rivastigmine (6 to 12 mg daily orally or 9.5 mg daily transdermally) appears to be beneficial for people with mild to moderate Alzheimer's disease. In comparisons with placebo, better outcomes were observed for rate of decline of cognitive function and activities of daily living, although the effects were small and of uncertain clinical importance. There was also a benefit from rivastigmine on the outcome of clinician's global assessment. There were no differences between the rivastigmine group and placebo group in behavioural change or impact on carers. At these doses the transdermal patch may have fewer side effects than the capsules but has comparable efficacy. The quality of evidence is only moderate for all of the outcomes reviewed because of a risk of bias due to dropouts. All the studies with usable data were industry funded or sponsored.

J Pak Med Assoc. 2012. Efficacy of rivastigmine in comparison to ginkgo for treating Alzheimer's dementia. To assess the efficacy of the Ginkgo biloba in patients with dementia of the Alzheimer type in slowing down the disease's degenerative progression and the patients' cognitive impairment compared with rivastigmine.METHODS:Total 56 patients aged 50-75 years, suffering from dementia, were allocated into one of the two treatments: group 1) Ginkgo biloba (120 mg daily dose); group 2) rivastigmine (4.5 mg daily dose) in a 24-week randomized double blind study. The degree of severity of dementia was assessed by the Seven Minute test and the Mini-Mental State Examination. Our results confirm the clinical efficacy of rivastigmine in the dementia of the Alzheimer type, comparing to Ginkgo biloba. There are few published trials that have directly compared a cholinesterase inhibitor with Ginkgo for dementia. This study directly compares a cholinesterase inhibitor with Ginkgo biloba for dementia of the Alzheimer type. Our study suggests that there are differences in the efficacy of Ginkgo biloba and rivastigmine in the treatment of Alzheimer's dementia. In addition, this study suggested that cholinesterase inhibitors should be used in preference to Ginkgo biloba in patients with mild to moderate AD.