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About - Rivastigmine

Absorbed through the skin: Treats dementia (memory loss and mental changes) associated with Alzheimer disease or Parkinson disease. This medicine is an acetylcholinesterase inhibitor.

By mouth: Treats dementia.

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Results: 1 to 20 of 65

The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease

Bibliographic details: Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, Clegg A.  The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technology Assessment 2006; 10(1): 1-176

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Cholinesterase inhibitors in Alzheimer's disease: supplementary commission rivastigmine patches and galantamine: Executive summary of final report A09-05, Version 1.0

The aims of the present investigation were to update the assessment of the benefit of galantamine and to assess the benefit and added benefit of rivastigmine as a transdermal patch in patients with mild to moderate Alzheimer's disease with respect to patient-relevant outcomes.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 3, 2012

Metaanalysis of randomized trials of the efficacy and safety of donepezil, galantamine, and rivastigmine for the treatment of Alzheimer disease

The authors estimated the effects of each of the three commonly used drugs for Alzheimer disease (donepezil, galantamine, and rivastigmine) in terms of predefined clinical outcomes and trial completion rates, by dosing level, and described differences among them. Using both electronic and manual search strategies (January 1992 to July 2002), a metaanalysis examined the effect of the drugs on clinical outcomes and completion rates. Regression analyses compared the effect of dose on clinical outcomes and completion rates, using 10 donepezil, 6 galantamine, and 5 rivastigmine articles. All three drugs showed beneficial effects on cognitive tests, as compared with placebo. For donepezil and rivastigmine, larger doses were associated with larger effect. This was not the case with galantamine. The odds of clinical global improvement demonstrated superiority over placebo for each drug, with no dose effects noted. Dropout rates were greater with galantamine and rivastigmine. There was little difference in dropout rate for each drug at each dose-level, except with high-dose donepezil. This was accounted for by the high dropout rate in two 52-week studies using larger doses. In summary, all three drugs had similar cognitive efficacy, with donepezil and rivastigmine showing a dose effect across the dosing levels studied. However, both galantamine and rivastigmine were associated with a greater risk of trial dropout than placebo, especially at higher dosing levels.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Rivastigmine for dementia in people with Down syndrome

The drug rivastigmine has been reported to have benefits for people with mild to moderate Alzheimer's disease who do not have Down syndrome. However, people with DS tend to present with AD at a much younger age than the general population as well as being physically different in terms of size, metabolism and heart rate, and may therefore have different requirements. This review identified no randomised controlled trials of rivastigmine in people with Down syndrome. Further research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease: a systematic review and meta-analysis

BACKGROUND: The role of currently available drugs for Alzheimer's disease (AD) has been controversial, with some national formularies restricting their use, and health economists questioning whether the small clinical effects are economically worthwhile.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

The Effectiveness and Cost-Effectiveness of Donepezil, Galantamine, Rivastigmine and Memantine for the Treatment of Alzheimer's Disease (Review of Technology Appraisal No. 111): A Systematic Review and Economic Model

Alzheimer's disease (AD) is the most commonly occurring form of dementia. It is predominantly a disease of later life, affecting 5% of those over 65 in the UK.

Health Technology Assessment - NIHR Journals Library.

Version: April 2012
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Cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine are efficacious for mild to moderate Alzheimer's disease

Alzheimer's disease is the commonest cause of dementia affecting older people, and is associated with loss of cholinergic neurons in parts of the brain. Cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine, delay the breakdown of acetylcholine released into synaptic clefts and so enhance cholinergic neurotransmission.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Rivastigmine is beneficial for people with Alzheimer's disease

Alzheimer's disease (AD) is the commonest cause of dementia affecting older people, and is associated with loss of cholinergic neurons in parts of the brain subserving aspects of memory. Acetylcholinesterase inhibitors, such as rivastigmine, delay the breakdown of acetylcholine released into synaptic clefts and may enhance cholinergic neurotransmission. There is evidence that rivastigmine is beneficial for people with Alzheimer's disease, in being associated with small improvements in the rate of decline of cognitive function and activities of daily living. Adverse effects were consistent with the cholinergic actions of the drug.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer's disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine

This review concluded that the evidence base regarding the efficacy of cholinesterase inhibitors for the behavioural and psychological symptoms of dementia was limited. The cautious conclusions reflected the evidence, but should be interpreted with caution due to the possibility of missed studies, lack of details on study quality and limitations in the synthesis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Rivastigmine appears to moderately improve cognition and to a lesser extent activities of daily living in patients with PDD

Dementia is frequently associated with Parkinson's Disease. While a number of neurotransmitters appear to be involved, loss of cholinergic functioning is particularly associated with Parkinson's Disease Dementia (PDD) suggesting a potential utility for cholinesterase inhibitors. Rivastigmine appears to moderately improve cognition and to a lesser extent activities of daily living in patients with PDD. There was a clinically meaningful benefit in 15% of patients. Efficacy in other domains requires confirmation. Tolerability in particular nausea, vomiting and tremor appear problematic.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Rivastigmine for vascular cognitive impairment

Vascular dementia (i.e. dementia caused by disease of blood vessels affecting the supply of blood to the brain) is one of the most common types of dementia. It includes dementia caused by stroke. It may exist by itself or with other common dementias such as Alzheimer's disease. Sometimes vascular disease can present with cognitive problems which are less severe than dementia. Those with vascular dementia may have significant cognitive impairment without major memory loss. The term vascular cognitive impairment (VCI) is useful, because of the range of different ways in which people are affected. Rivastigmine is a drug widely used in Alzheimer's disease (AD). It works by preventing breakdown of acetylcholine, a neurotransmitter (signalling molecule). Levels of acetylcholine are reduced in VCI as well as in AD and so it may also help people with VCI. Researchers searched for all trials that compared rivastigmine with placebo in people with VCI, and identified three. Only one of these showed any significant results, and it did show some benefit for people with VCI who took rivastigmine. However, nausea and vomiting were a frequent side effect of taking the drug. Therefore it remains uncertain how useful rivastigmine is for people with VCI .

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Efficacy and safety of donepezil, galantamine, and rivastigmine for the treatment of Alzheimer's disease: a systematic review and meta-analysis

This review concluded that cholinesterase inhibitors (donepezil, galantamine and rivastigmine) were able to stabilise or slow decline in cognition, function, behaviour and global change when compared with placebo. There was no clear evidence to determine whether one of these drugs was more efficacious than another. The review was generally well conducted and the conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease

Alzheimer's disease (AD) is the most common cause of dementia and is characterised by an insidious onset and slow deterioration in cognition, functional ability (e.g. activities of daily living) and behaviour and mood. AD prevalence rises with increasing age and the estimated prevalence of AD for a standard primary care trust with a population of 200,000 is approximately 1100. Current service involves a wide range of agencies. In 2001, the National Institute for Health and Clinical Excellence (NICE) recommended that cholinesterase inhibitors (donepezil, rivastigmine, galantamine) should be offered to patients with mild to moderate AD under a number of conditions. Patients with more severe AD may benefit from memantine but there is currently no guidance on its use.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2006

The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease (review of Technology Appraisal No. 111): a systematic review and economic model.

Alzheimer’s disease (AD) is the most commonly occurring form of dementia, accounting for approximately 62% of instances of dementia. AD is predominantly a disease of later life, with 5% of the UK population over 65 years affected. In England and Wales, among people aged 65–69 years, the incidence is estimated to be 7.4 [95% confidence interval (CI) 3.6 to 16.1] per 1000 person-years, rising to 84.9 (95% CI 63.0 to 107.8) per 1000 person-years at 85 years old and above. These rates predict 180,000 new cases of dementia per year and, if 62% of these have AD (see above), then there are approximately 111,600 new cases in England and Wales per year.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2012

Update search on report A05-19A (Cholinesterase inhibitors in Alzheimer's disease): Executive summary of rapid report A09-03, Version 1.0

In February 2007 the Institute for Quality and Efficiency in Health Care (IQWiG) produced a final report on “Cholinesterase inhibitors in Alzheimer's disease” (commission A05-19A). This final report represented the first in the series on the topic of “Alzheimer's disease”. When the fourth and last assessment (commission A05-19C: “Memantine in Alzheimer's disease”) was completed, the literature search for the final report A05-19A was already 3 years old. The Federal Joint Committee (G-BA) therefore commissioned IQWiG to determine whether substantive new evidence on cholinesterase inhibitors had been published since then that could decisively change the conclusions of that report so that a new assessment of cholinesterase inhibitors would be desirable.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 12, 2009

Cholinesterase inhibitors in Alzheimer’s disease: Executive summary of final report A05-19A, Version 1.0

The aims of this evaluation were: the evaluation of long-term treatment with a ChEI in Alzheimer’s disease compared with placebo; the evaluation of long-term treatment with a ChEI in Alzheimer’s disease compared with treatment with a different drug or non-drug intervention.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 7, 2007

Comparing Alzheimer's Drugs

How do Alzheimer's drugs compare for treating symptoms?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: January 1, 2008

Alzheimer's disease: How effective are cholinesterase inhibitors?

Cholinesterase inhibitors can slightly delay the loss of mental abilities in people who have mild to moderate Alzheimer’s disease. But these medications may also cause nausea, vomiting or dizziness.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 18, 2013

Medications for the treatment of Alzheimer’s disease

There is currently no cure for Alzheimer’s disease. Various medications can somewhat delay the loss of mental abilities and independence. But they can also have side effects. It is not clear whether any of the medications are better than the others.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 21, 2013

Delirium: Screening, Prevention, and Diagnosis – A Systematic Review of the Evidence [Internet]

Delirium is a common syndrome in hospitalized or institutionalized adults. It is characterized by the acute onset of altered mental status, hallmarked by difficulty sustaining attention and a fluctuating course. Delirium frequently causes patients, families, and health care providers considerable distress. The incidence varies widely based on patient population, setting, and intensity of diagnostic ascertainment with reported values of 10% to over 80%. Delirium is associated with multiple serious outcomes including increased morbidity, length of hospital stay, healthcare costs, institutionalization, and mortality. In surgical settings, older adults and those with multiple medical conditions are at increased risk for postoperative delirium. Delirium may be under-recognized by healthcare providers and it can be difficult to resolve. Several brief “bedside” questionnaires and checklists exist that can help detect delirium earlier and among those with milder symptoms. Additionally, efforts to prevent the development of delirium in those at risk have been advocated. Medications (including sedatives, narcotics, and anticholinergic drugs), diseases and intercurrent illnesses (e.g., stroke, infection, shock, anemia), surgical procedures (especially orthopedic and cardiac surgery), and environmental factors (e.g., use of a bladder catheter, pain, and emotional stress) are all associated with delirium. Therefore, identifying and implementing effective strategies to prevent and detect delirium could improve clinical outcomes and resource utilization. Suggested strategies to prevent delirium include avoidance of psychoactive medications, pharmacologic interventions to decrease risk, and single- or multi-component non-pharmacologic interventions (including use of music, mobilization, fluid and nutrition management, and orientation and cognitive stimulation).

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: September 2011
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