Rivastigmine: new product. No better than donepezil

(1) Rivastigmine is the third anticholinesterase to be approved for treating Alzheimer's disease, after tacrine and donepezil. (2) The clinical evaluation dossier comprises only 3 double-blind, placebo-controlled trials of good methodological quality. (3) Rivastigmine showed some effect on the scores of validated scales, but the clinical relevance of this is doubtful. Only 4% of patients are likely to benefit from rivastigmine 6-12 mg daily. Clinical outcome after 6 months of treatment is not known. Note that these trials were not published in detail. (4) Cholinergic reactions have been reported. Note that for donepezil, no adverse effects on the liver have been observed.