Fortea_2025_Expert.Rev.Neurother__1

INTRODUCTION: Rivastigmine, a cholinesterase inhibitor, was first approved for the treatment of Alzheimer's disease (AD) dementia more than 20 years ago. Initially available as an oral formulation, a transdermal system was subsequently developed with the aim of improving tolerability while providing similar efficacy. Transdermal rivastigmine is approved for the treatment of severe AD as well as mild-to-moderate AD. AREAS COVERED: Herein, the authors review randomized clinical trials, meta-analyses, and post-marketing observational studies involving the rivastigmine 13.3 mg/24 h patch for the treatment of patients with AD. EXPERT OPINION: Cholinesterase inhibitors are a mainstay of the symptomatic treatment of patients with AD. Rivastigmine is available as oral and transdermal formulations, with the latter providing improved tolerability and convenience while maintaining efficacy. The high-dose 13.3 mg/24 h patch might offer benefits for some patients compared to the lower dose patch (4.6 mg/24 h) in patients with mild-to-moderate or severe AD, showing improvements in daily functioning and global clinical status on top of the cognitive benefits. The ability to titrate up to a dose of 13.3 mg/24 h provides an option for patients with severe AD or with an inadequate response to lower doses of rivastigmine.