Letter. Spontaneous rupture of oesophagus (Boerhaave's syndrome) related to rivastigmine

Babic, Tamara; Banfic, L.; Papa, J; Barišić, Nenad; Jelinčić, Željko; Zurak, Niko

doi:10.1093/ageing/29.4.370

Cited by 11 publications

(8 citation statements)

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“…An episode of severe vomiting with esophageal rupture has been reported after re-initiation of rivastigmine therapy at an inappropriate single dose (4.5 mg) after treatment was interrupted for weeks (Babic et al 2000). No clinically relevant changes in laboratory or vital signs (including hepatic enzymes) were observed with rivastigmine 6 to 12 mg/day, except for a ≥7% decrease in body weight reported in about one-fifth of patients (Corey-Bloom et al 1998; Rosler et al 1999).…”

Section: Tolerabilitymentioning

confidence: 99%

Rivastigmine in the treatment of Alzheimer's disease: an update

Onor¹,

Trevisiol²,

Aguglia³

2007

Clinical Interventions in Aging

136

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Alzheimer’s disease is the most common form of dementia in industrialized countries. In the European Union, about 54% of dementia cases are believed to be due to Alzheimer’s disease. The condition is an age-related neurodegenerative disorder characterized by multiple cognitive deficiencies, including loss of memory, judgment, and comprehension. These manifestations are accompanied by behavioral and mood disturbances. Although no cure has yet been discovered for Alzheimer’s disease, symptomatic therapies are now widely available and offer significant relief to patients and benefits to caregivers in terms of reduced care burden. At the start of the 21st century, health technology assessments recommended three agents for the symptomatic treatment of mild to moderate Alzheimer disease: rivastigmine, donepezil, and galantamine. Rivastigmine (Exelon®, Novartis Basel—Switzerland) is a slowly reversible inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), while donepezil (Aricept®, Pfizer, New York, USA) and galantamine (Reminyl®, Janssen, New Jersey,USA) show no functional inhibition of BuChE, and are considered AChE-selective, rapidly-reversible inhibitors. The efficacy of all three agents has been evaluated in large, double-blind, placebo-controlled clinical trials of up to 6 months’ duration. Rivastigmine treatment in mild to moderate Alzheimer’s disease improves cognition, activities of daily living, and global function.

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Section: Tolerabilitymentioning

confidence: 99%

Rivastigmine in the treatment of Alzheimer's disease: an update

Onor¹,

Trevisiol²,

Aguglia³

2007

Clinical Interventions in Aging

136

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“…A rapid increase of central ACh leads to increased release of dopamine from the area postrema of the hypothalamus, resulting in nausea and vomiting. Oesophageal rupture has been associated with rivastigmine [80], most likely secondary to severe vomiting [81]. Due to these GI side effects, caution should be used when prescribing ChEIs to those with peptic ulcer disease.…”

Section: Gastrointestinal Adverse Eventsmentioning

confidence: 99%

The benefits and risks associated with cholinesterase inhibitor therapy in Alzheimer’s disease

Thompson

Lanctôt

Herrmann

2004

Expert Opinion on Drug Safety

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The 'second-generation' cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine, are a class of medications that are currently approved for the treatment of mild-to-moderate Alzheimer's disease (AD). These medications have proven efficacy in improving cognition, behaviour, activities of daily living, and global functioning in mild-to-moderate AD. They have also been shown to reduce caregiver stress and to delay time to nursing home placement. Two separate meta-analyses have indicated that ChEIs confer a modest but significant therapeutic benefit in the treatment of AD, despite higher rates of treatment discontinuation and side effects than placebo. There is growing evidence to support their efficacy in treating moderate-to-severe AD. ChEIs are generally well-tolerated, with side effects that tend to be dose-related and are most problematic during dose titration. The most common adverse effects, related to cholinergic stimulation in the brain and peripheral tissues, include gastrointestinal, cardiorespiratory, extrapyramidal, genitourinary, and musculoskeletal symptoms, as well as sleep disturbances. Few clinically significant drug-drug interactions with ChEIs have been identified. Three head-to-head trials of ChEIs in the treatment of AD have been published to date, but are limited due to their open-label design, rates of titration, and the drug dosage levels utilised. Further study is needed to examine other indications for ChEIs, as well as their combination with newer treatments, such as memantine.

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“…4 7 , 4 9 One case of Boerhaave's syndrome (spontaneous rupture of the esophagus) from retching/vomiting has been reported with rivastigmine. 51 A warning letter was sent out by Health Canada in 2001 advising physicians to re-titrate rivastigmine if treatment was interrupted by more than several days. Slower titration and administering rivastigmine with food appears to decrease the risk of GI side effects.…”

Section: Adverse Effectsmentioning

confidence: 99%

Progress in Clinical Neurosciences: Treatment of Alzheimer’s Disease and Other Dementias - Review and Comparison of the Cholinesterase Inhibitors

Hogan

Patterson

2002

Can. j. neurol. sci.

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306Alzheimer's disease (AD) is the most common type of dementia encountered in older patients.1,2 To date, the most successful pharmacological approach to the treatment of AD has been with cholinesterase inhibitors (ChEIs) which are felt to increase acetylcholine (ACh) levels in the central nervous system (CNS) by interfering with the hydrolysis of ACh by acetylcholinesterase (AChE) and/or butyrylcholinesterase (BuChE). In this paper we will review the ChEIs approved by the Therapeutics Products Program of Health Canada for the symptomatic treatment of AD. We will compare these three agents (listed in order of approval -donepezil, rivastigmine, and galantamine) and give guidance as to who should be treated with what and how. A B S T R A C T: B a c k g r o u n d :A l z h e i m e r's disease (AD) is the most common cause of dementia in older adults. Acceptance of the c h o l i n e rgic hypothesis led to a search for medications which could enhance central cholinergic activity in this condition. There are now three cholinesterase inhibitors available for the treatment of AD in Canada. O b j e c t i v e s : To review the currently available cholinesterase inhibitors approved for the treatment of AD in Canada and to provide guidance on who and how to treat with these agents. R e s u l t s : D o n e p e z i l , rivastigmine, and galantamine are approved for the treatment of AD in Canada. In clinical trails, patients with mild to moderate AD treated with these agents experienced modest improvements in cognition, function, behaviour, and/or global clinical state. The magnitude of benefits seen with each agent appeared to be similar. While to date, there is no convincing evidence that one is more efficacious or effective, they do differ in their pharmacokinetics, additional mechanisms of action, and side effect profiles. Therefore, the selection of agent will be based on considerations such as side effect profiles, ease of administration, personal familiarity/experience, and beliefs about the importance of the noted differences in their pharmacokinetics and additional mechanisms of action. Conclusion: We believe that these agents should be offered to all individuals with a mild to moderate dementia where Alzheimer's pathology is felt to be a contributing factor. We view all three available cholinesterase inhibitors as first-line drugs. RÉSUMÉ: Traitement de la maladie d'Alzheimer-Revue et comparaison des inhibiteurs de la cholinestérase. I n t r o d u c t i o n :La maladie d'Alzheimer (MA) est la cause la plus fréquente de démence chez les personnes âgées. L'acceptation de l'hypothèse cholinergique a mené à la recherche de médicaments qui pourraient augmenter l'activité cholinergique centrale dans cette maladie. Il y a maintenant trois inhibiteurs de la cholinestérase qui sont disponibles au Canada pour le traitement de la maladie d'Alzheimer. O b j e c t i f s : Revoir les inhibiteurs de la cholinestérase qui sont actuellement disponibles et approuvés pour le traitement de la MAau Canada et fournir des conseils sur le t...

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Letter. Spontaneous rupture of oesophagus (Boerhaave's syndrome) related to rivastigmine

Cited by 11 publications

References 0 publications

Rivastigmine in the treatment of Alzheimer's disease: an update

Rivastigmine in the treatment of Alzheimer's disease: an update

The benefits and risks associated with cholinesterase inhibitor therapy in Alzheimer’s disease

Progress in Clinical Neurosciences: Treatment of Alzheimer’s Disease and Other Dementias - Review and Comparison of the Cholinesterase Inhibitors

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