[Changing the anticholinesterase in Alzheimer's disease]. / Cambio de anticolinesterásico en la enfermedad de Alzheimer.

AIM: To review the available information related to the switch of one cholinesterase inhibitor (CEI) by other CEI in Alzheimer's disease. DEVELOPMENT AND CONCLUSIONS: The distinct pharmacological profile of CEI supports the switch, which can be considered in three scenarios: poor tolerability, lack of efficacy at the beginning of the treatment and long-term loss of efficacy. A poor tolerability to one CEI predisposes to not tolerating a second CEI, but this is not so much when a washout period is kept. Under these circumstances, the switch can be performed if the adverse events are minor and do not represent a risk for the patient. Switching the CEI is also advisable in case of lack of efficacy at the beginning of treatment. In this situation, some observational studies have shown a response to rivastigmine in approximately half of patients who had not responded to donepezil. Switching in other directions is also reasonable, but has been less investigated. As for the third scenario, i.e. long-term loss of efficacy, there are not sufficient available data to indicate the switch. This practice should be kept for research purposes only.

Cambio de anticolinesterásico en la enfermedad de Alzheimer / Changing the anticholinesterase in alzheimer´s disease

Aim. To review the available information related to the switch of one cholinesterase inhibitor (CEI) by other CEI in Alzheimer’s disease. Development and conclusions. The distinct pharmacological profile of CEI supports the switch, which can be considered in three scenarios: poor tolerability, lack of efficacy at the beginning of the treatment and long-term loss of efficacy. A poor tolerability to one CEI predisposes to not tolerating a second CEI, but this is not so much when a washout period is kept. Under these circumstances, the switch can be performed if the adverse events are minor and do not represent a risk for the patient. Switching the CEI is also advisable in case of lack of efficacy at the beginning of treatment. In this situation, some observational studies have shown a response to rivastigmine in approximately half of patients who had not responded to donepezil. Switching in other directions is also reasonable, but has been less investigated. As for the third scenario, i.e. long-term loss of efficacy, there are not sufficient available data to indicate the switch. This practice should be kept for research purposes only (AU)

Objetivo. Revisar la información disponible en relación con el cambio de un inhibidor de la colinesterasa (ICE) por otro ICE en la enfermedad de Alzheimer. Desarrollo y conclusiones. El diferente perfil farmacológico de los ICE apoya el cambio, que puede plantearse en tres situaciones: mala tolerancia, falta de eficacia al inicio del tratamiento y pérdida de efecto a largo plazo. La mala tolerancia a un primer ICE predispone a no tolerar un segundo ICE, pero este riesgo disminuye si se realiza un período de ‘lavado’. En esta situación, el cambio está justificado en caso de efectos adversos menores, que no conlleven riesgo para el paciente. También es aconsejable el cambio de ICE ante la falta de eficacia al inicio del tratamiento. En esta situación, los estudios observacionales han demostrado una respuesta a la rivastigmina aproximadamente en la mitad de los pacientes que no respondieron al donepecilo. Cambios en otras direcciones también son razonables, pero han sido menos estudiados. En el tercer supuesto, la pérdida de efecto a largo plazo, no existen datos suficientes para aconsejar el cambio de ICE. Esta práctica debería reservarse para el ámbito de la investigación (AU)