Donepezil vs. Rivastigmine Patches for Alzheimer’s-Related Dementia
Key takeaways:
Donepezil patches (Adlarity) and rivastigmine patches (Exelon) are FDA-approved to treat Alzheimer’s-related dementia.
Donepezil is a once-weekly patch, and rivastigmine is a once-daily patch. The donepezil patch should be available in the U.S. in fall 2022.
Donepezil and rivastigmine patches work similarly, but they have some differences in dosage, storage, and side effects.
If you’re like most people, the thought of dementia may cross your mind as you or a loved one grow older. For understandable reasons, dementia symptoms can be intimidating and change the way you approach day-to-day life.
There are actually several types of dementia, but the kind caused by Alzheimer’s disease is the most common. And while there’s currently no cure, many medications are available to help manage symptoms of Alzheimer’s-related dementia.
Still, the nature of the condition can eventually make it hard to accomplish certain tasks, such as swallowing a pill. To help with this, you or a loved one may be interested in trying an easy-to-use patch that’s applied to the skin.
Currently, there are two patches approved to treat Alzheimer’s-related dementia: donepezil (Adlarity) and rivastigmine (Exelon). The rivastigmine patch has been available since 2007, but the donepezil patch was approved in March 2022.
Here, we’ll discuss these two treatment options for Alzheimer’s-related dementia: how they work, how they compare to oral medications, and how they stack up to each other.
What is donepezil (Adlarity)?
Donepezil is a first-choice medication to treat Alzheimer’s-related dementia. You may have heard it called Aricept, which is the tablet version. But, in March 2022, the FDA approved a patch formulation of donepezil called Adlarity. It’s expected to be available in the U.S. in early fall 2022, as a brand-name-only product.
What is donepezil approved to treat?
Donepezil is approved to treat mild, moderate, and severe Alzheimer’s-related dementia. It’s not FDA-approved to treat dementia caused by other conditions, such as Parkinson’s disease or Huntington’s disease.
What is rivastigmine (Exelon)?
Rivastigmine is another medication that’s approved to treat Alzheimer’s-related dementia. It comes in two formulations: a capsule taken by mouth 2 times a day and a skin patch that’s replaced every 24 hours. The patch is available as both a brand-name product, called Exelon, and as a lower-cost generic.
What is rivastigmine approved to treat?
Rivastigmine is approved to treat mild, moderate, and severe Alzheimer’s-related dementia. It’s also approved to treat mild to moderate Parkinson’s-related dementia.
How do cholinesterase inhibitors work for dementia?
Donepezil and rivastigmine are both cholinesterase inhibitors.
They work by raising the amount of acetylcholine that’s available in your brain. Acetylcholine is a chemical that helps with memory, attention, and motivation. Donepezil does this by blocking one enzyme in your brain (acetylcholinesterase), and rivastigmine does this by blocking two enzymes (acetylcholinesterase and butyrylcholinesterase).
Why is this helpful? In Alzheimer’s disease, there’s less acetylcholine than normal in the brain. This leads to problems with memory and learning. Medications like donepezil and rivastigmine help fight acetylcholine-related problems. They can improve symptoms of memory loss and difficulty thinking, but they don’t target the underlying cause of Alzheimer’s disease.
What are the dosages for donepezil and rivastigmine patches?
As mentioned, donepezil and rivastigmine patches are both applied to your skin. But there are several differences in doses and application to keep in mind.
| Donepezil patches | Rivastigmine patches | |
|---|---|---|
| Available doses | 5 mg 10 mg |
4.6 mg 9.5 mg 13.3 mg |
| Typical starting dose | 5 mg | 4.6 mg |
| Replacing your patch | Apply new patch every 7 days | Apply new patch every 24 hours |
| Ideal storage conditions | Fridge | Room temperature |
| Application sites | Back Upper buttock Outer thigh |
Back Upper arm Chest |
Regardless of which medication you use, it’s a good idea to rotate where you apply the patch to avoid skin irritation. Both patches can be worn during bathing and in hot weather, but you should avoid spending long periods of time under direct sun or in a sauna.
With either, if the patch falls off or if you miss a dose, put on a new patch right away and continue your usual cycle. But always remember to remove the old patch before placing a new one. (You should never wear two patches at the same time.)
How effective are donepezil and rivastigmine patches for treating Alzheimer’s-related dementia?
Donepezil tablets are the most commonly used medication to treat Alzheimer’s-related dementia. But donepezil patches have been shown to provide a similar clinical benefit to the tablets. A donepezil patch might take a little longer to start working compared to taking a tablet by mouth, but it works just as well.
Rivastigmine has been shown to work as well as donepezil at treating Alzheimer’s-related dementia. And when comparing the two versions of rivastigmine, the patches have shown to provide a similar clinical benefit to the capsules.
In other words, donepezil and rivastigmine patches are similarly effective to their oral counterparts. But the patches can be especially useful if you have trouble swallowing pills or have a sensitive stomach.
What are the known side effects of donepezil and rivastigmine patches?
Donepezil and rivastigmine both have the potential to cause side effects. But rivastigmine appears to cause side effects more frequently, generally making donepezil the preferred option.
However, it’s still important to consider the possible side effects of both medications. Below are common side effects for each medication and the likelihood they may occur. Keep in mind that these side effects can vary by person and by patch strength.
| Side effect | Donepezil patches | Rivastigmine patches |
|---|---|---|
| Headache | 15% | 4% |
| Muscle spasms | 9% | – |
| Insomnia | 7% | 4% |
| Itchiness or irritation at the application site | 6%-9% | 4% |
| Abdominal pain | 6% | 4% |
| Constipation | 6% | – |
| Diarrhea | 4% | 6% |
| Dizziness | 4% | 4% |
| Nausea | – | 12% |
| Vomiting | – | 10% |
| Risk of falling | – | 8% |
| Lower appetite than normal | – | 6% |
Notably, for both medications, the patches are less likely to cause stomach and intestinal side effects than their oral versions. This is because the medication in the patch is directly absorbed through the skin and into the blood. It doesn’t pass through your stomach.
What are the serious side effects of donepezil and rivastigmine patches?
Serious side effects are rare with donepezil and rivastigmine patches. But if you experience any of these side effects, contact your healthcare provider right away:
Very slow heart rate, especially if you have a heart condition
Seizures
Worsening chronic obstructive pulmonary disease (COPD) or asthma symptoms
What interactions do donepezil and rivastigmine have?
Donepezil and rivastigmine patches can potentially interfere with anticholinergic medications, which are used to treat several health conditions. Anticholinergic medications work by blocking the activity of acetylcholine in the body. And they are typically used to treat conditions like overactive bladder (medications like oxybutynin and tolterodine) and irritable bowel syndrome (medications like dicyclomine and hyoscyamine).
Donepezil and rivastigmine patches can also interfere with succinylcholine, a medication used for anesthesia. Make sure to check with your healthcare provider if you have a planned surgical procedure.
The rivastigmine patch may also interact with metoclopramide and medications that slow the heart rate, such as beta blockers.
Check with your healthcare provider or pharmacist to see if any of your other medications could interfere with the patches.
How much do donepezil and rivastigmine patches cost?
The rivastigmine patch is available as a generic medication, which is cheaper than the brand-name product. The average retail price for a typical monthly supply of generic rivastigmine patches is around $484. With a GoodRx coupon, the price may be as low as around $71.
We don’t know how much donepezil patches will cost yet. But they’ll only be available as a brand-name medication, so they’ll likely be more expensive. More information about the cost will be available as we approach the launch date, later this year.
Can you use donepezil and rivastigmine patches together for Alzheimer’s-related dementia?
No, donepezil and rivastigmine belong to the same class of medications, and they shouldn’t be used together. Using them at the same time can worsen the side effects of either medication and won’t provide additional benefits.
The bottom line
Donepezil and rivastigmine are both used to treat Alzheimer’s-related dementia. The donepezil patch is the second Alzheimer’s disease medication approved in a patch formulation, following in rivastigmine’s footsteps.
Donepezil and rivastigmine patches work similarly to each other. But donepezil is a once-weekly patch that must be kept in the fridge, and rivastigmine is a once-daily patch that is stored at room temperature. Make sure to talk to your healthcare provider about the pros and cons of each to see which one may be right for you.
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References
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