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Adverse drug events affecting medication persistence with rivastigmine patch application.

Takashi Osada1, Norio Watanabe1, Naomitsu Asano2

  • 1Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan, t-osada@dpc.agu.ac.jp.

Patient Preference and Adherence
|July 28, 2018
PubMed
Summary

Rivastigmine patches for Alzheimer's disease often cause skin reactions, leading to treatment discontinuation. Most patients experienced these adverse events before reaching the maintenance dose, highlighting challenges in effective Alzheimer's treatment.

Keywords:
Alzheimer’s diseaseapplication site reactionscommunity pharmacymedication persistencerivastigmine patch

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Area of Science:

  • Neurology
  • Pharmacology
  • Dermatology

Background:

  • Rivastigmine transdermal patch is the sole cholinesterase inhibitor delivery system for Alzheimer's disease.
  • It offers benefits in cognitive function, daily living activities, and patient adherence.
  • However, cutaneous adverse events frequently complicate treatment, hindering dose escalation and continuation.

Purpose of the Study:

  • To investigate the incidence and characteristics of adverse events associated with the rivastigmine patch.
  • To examine medication persistence in Alzheimer's disease patients using the rivastigmine patch.
  • To understand the relationship between adverse events, dosage, and treatment discontinuation.

Main Methods:

  • Retrospective examination of medication counseling records for 312 Alzheimer's disease patients prescribed rivastigmine patches.
  • Data collected from July 2011 to March 2015 at Toki Medical Clinic and Sasayuri Community Pharmacy.
  • Outcomes assessed included adverse event manifestation, dose at manifestation, dose reduction, and discontinuation.

Main Results:

  • Adverse drug events occurred in 67.0% (209/312) of patients, with 70% experiencing them before the 18 mg maintenance dose.
  • Cutaneous reactions (rash, erythema) were most common (59.6%), followed by gastrointestinal disorders (9.3%).
  • Discontinuation occurred in 37.8% (118/312), primarily due to application site reactions (62.7% of discontinuations).

Conclusions:

  • Approximately 60% of patients experienced application site reactions, impeding dose escalation and treatment continuation.
  • Around 80% of patients discontinuing due to skin reactions developed them upon reaching the 9 mg dose.
  • These findings underscore the challenges posed by cutaneous adverse events in rivastigmine patch therapy for Alzheimer's disease.