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| |  AGS: Donepezil and Rivastigmine May Be Combined In Alzheimer’s Patients By W. A. Thomasson Special to DG News CHICAGO, IL -- May 12, 2001 -- Research suggests that combined use of donepezil and rivastigmine may sometimes by helpful for enhancing cognitive function among patients with Alzheimer's disease. Cholinesterase inhibitors have typically been used as single agents for these patients. The new findings were presented Friday (May 11) at the annual meeting of the American Geriatrics Society by J. R. Shua-Hain, MD, and his colleagues at Meridian (NJ) Hospitals Corporation. Observations began as part of a study on the best way to switch to rivastigmine those patients who were no longer doing well on donepezil. One of the three methods being compared involved a one-week overlap in administration of the two drugs: First, the dose of donepezil was reduced from 10 mg/day to 5 mg/day, then rivastigmine was added at an initial dose of 1.5 mg/day. After three days with no adverse events, the rivastigmine dose was increased to 1.5 mg bid. At the end of the one-week overlap, donepezil was supposed to be discontinued. During this one-week overlap, according to S. Amin, MD, one of the paper's authors, "In 59 percent [of the 44 patients], the family noticed significant improvement in [patient] cognition with no significant side effects." This improvement was seen mostly in improved language skills with greater reliability. Functional performance was also reported to improve, but memory did not. Fourteen caregivers were so impressed with the improvement that they insisted on continuing combination therapy, even though they were repeatedly informed that there was no published evidence to support this approach and that their insurance would not cover the cost of the second drug. Addressing the reason for this perhaps-unexpected success of combination therapy, Dr. Amin noted that, "Even though [the two drugs] are both cholinesterase inhibitors, they act on different receptors. That might be the reason there was significant improvement in cognition." He continued, "It's very preliminary data right now, but it works very well for us. It might have a role in the future in improving cognition."
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