Treatment of dementia syndromes using modern transdermal delivery systems

Alzheimer’s disease is the leading cause of dementia worldwide and remains one of the greatest challenges of modern medicine. In the absence of disease-modifying therapies, symptomatic treatment with cholinesterase inhibitors and memantine constitutes the cornerstone of clinical management. Rivastigmine is a unique cholinesterase inhibitor that acts on both acetylcholinesterase and butyrylcholinesterase and is available in oral and transdermal formulations. This narrative review summarises current evidence on the role of rivastigmine in the treatment of Alzheimer’s disease, with particular emphasis on transdermal delivery systems. It also discusses the pharmacological properties, clinical efficacy, tolerability, and safety of oral and transdermal rivastigmine, as well as practical aspects of treatment initiation and switching from oral to transdermal therapy. In addition, recent data on extended-interval transdermal systems applied twice weekly are reviewed. Transdermal formulations of rivastigmine provide more stable plasma drug concentrations, improved gastrointestinal tolerability, and enhanced treatment adherence compared with oral formulations. Extended-interval transdermal systems may further reduce the burden for patients and caregivers, potentially improving treatment effectiveness in real-world clinical practice. Rivastigmine transdermal therapy represents a valuable option in the symptomatic treatment of Alzheimer’s disease, particularly in patients with poor tolerance of oral therapy or difficulties with treatment adherence.