My Dad who is 85 has been using the Exelon patch for several months. The itching was so bad that his neurologist gave us a RX for Flonase to put on daily where the old patch was taken off. This has helped with the itching but the reddness - almost a burn maybe still occurs. Any suggestions to help my Dad would be appreciated. Thank you.

Hi Kim,

I'm a behavioral neurologist who treats a lot of people with Alzheimer disease and other dementias. For "full disclosure" I must point out I also occasionally speak for Pfizer and Eisai, the companies who market and make Aricept, but you can easily check up on anything I say and I think you'll find I'm being factual.

My advice for your father is to get him off the Exelon patch and onto an oral form of either Exelon, Aricept, or Razadyne.

Here's the deal with these drugs, called "cholinesterase inhibitors" (CEIs). All CEIs have shown equal efficacy in controlled studies, at their maximum doses. That's Exelon 6 mg twice a day, Aricept 10 mg once a day, or Razadyne 12 mg twice a day (there's a once-a-day form of Razadyne but it's questionable, based upon the only published study with this dose form, as to whether in fact it is equivalent to other drugs).

In my experience, drug reps tell doctors that Exelon patch is better because it's more convenient than pills and because it "gives all the power of Exelon without the side effects" (Exelon pills are much more likely than the other drugs to cause nausea or vomiting).

Trouble is, Exelon is no more "powerful" than other CEIs. And the patch that is marketed, the "Patch 10," appears less efficacious than other drugs. The only published controlled study with the patch showed an "effect size" on a measure of thinking, the ADAS-Cog, of about 1.5 points, compared to about 3 points seen on Aricept, Exelon capsules, or Razadyne in their early studies (though Exelon studies show more variability of response, with one early study showing an effect of only 1.6 points). The "Patch 20" had an effect size closer to 3, but had more side effects, so the company markets the Patch 10. Note also, the initial or starting dose of the patch was no more effective than placebo in the study--you must increase to the "target dose" of "Patch 10" before you get an effective dose. My experience has been that quite a few people get side effects on that dose of patch, but it would require applying two patches a day to expect similar efficacy as other CEIs, and it's even more likely there would be side effects.

I also question whether the patch could be considered "more convenient." You have to apply it every day, and take off the previous patch, and be careful not to apply it to the same spot for several days, and be able to keep it on all day, etc. With pills, people just swallow them and they're done. With Aricept, that's only once a day (and with Aricept ODT they don't even have to swallow the pill, as it dissolves in the mouth).

Because Aricept has less risk of side effects and is easier to dose, it's the most commonly prescribed drug, and therefore the other companies try very hard to convince doctors that their drug is better than Aricept, so those doctors will use the other drugs. There is no evidence, however, that any of the CEIs is superior to the others, at their full doses. As I say, though, that's not true for the patch, which appears less efficacious than other drugs and dose forms. And it also appears that Namenda, which is not a CEI, is less efficacious on its own than any one of the CEIs (though given along with a CEI it can "boost" the benefit of the CEI).

If, however, someone can't take pills for some reason, like their mouth won't open, then the patch would be a reasonable alternative.

Mark,

I commend you for your information and your full disclosure.

My Mom used the Exelon patch for about 4 months, with no effectiveness at all, in fact she went spiraling downhill. I'm not saying Exelon hurt her, but it definitely didn't help. We didn't have any trouble with the patch site though.

Felicia

My 79 year old husband was diagnosed with Lewy Bodys in 2005. He has been maintained on Sinemet and Exelon His most recent medications have been apo-levocarb cr 50-200 - 1/2 pill in the morning along with 1 pill apo-levocarb 100mg&25mg. He had 3mg exelon in the morning, too.
Before lunch and dinner he had 1/2 - 100mg&25. At dinner he had another 3mg exelon and before bed a 1.5 mg exelon.
Recently he has been having more halucinations and other slowing down and the Dr. felt a change to the exelon of the 10mg patch would help.(Pills stopped) He is on his thirteenth day today and seems to be getting worse instead of stabilizing or getting better.I can not find if there are any side effects from the patch and would apprieciate any comments on this.
Beth McCulloch

Beth --

Go to:

www.rxlist.com/cgi/generic/exelon-patch_ad.htm

If your doctor is open to discussing alternative treatments, there is another cholinesterase inhibitor, called "huperzine A", which is supposedly more effective yet has fewer side effects than either exelon or aricept.

It has been widely used in China to treat AD, and is now in a major clinical trial in the U.S. to confirm these reports. It is sold over the counter in the U.S. as an herbal supplement, so it is readily available. My husband was in the trial -- he just completed 72 weeks of the "open" stage in which we knew he was on "the real thing". He did very well -- his test scores remained stable for the 72-week period. (He is also on namenda.) The only problem he ever had was mild nausea, and that went away when I gave him the pills after meals.

A two-month supply of huperzine A runs about $10.

And in the interests of full disclosure, I have no relationship whatsoever with any company or entity that tests, researches, produces, or sells huperzine A or namenda.

If your doctor suggests giving it a try, be sure to get a preparation that does NOT have a lot of other things added. My husband is currently on 200 mcg twice a day (you should build up to this level a little at a time), and the clinical trial people recommended going up to 400 mcg when/if my husband starts to slip a little.