[Changing the anticholinesterase in Alzheimer's disease]

To review the available information related to the switch of one cholinesterase inhibitor (CEI) by other CEI in Alzheimer's disease.

The distinct pharmacological profile of CEI supports the switch, which can be considered in three scenarios: poor tolerability, lack of efficacy at the beginning of the treatment and long-term loss of efficacy. A poor tolerability to one CEI predisposes to not tolerating a second CEI, but this is not so much when a washout period is kept. Under these circumstances, the switch can be performed if the adverse events are minor and do not represent a risk for the patient. Switching the CEI is also advisable in case of lack of efficacy at the beginning of treatment. In this situation, some observational studies have shown a response to rivastigmine in approximately half of patients who had not responded to donepezil. Switching in other directions is also reasonable, but has been less investigated. As for the third scenario, i.e. long-term loss of efficacy, there are not sufficient available data to indicate the switch. This practice should be kept for research purposes only.