Rivastigmine
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Rivastigmine REM sleep behaviour disorder in an elderly patient: case report An 88-year-old man with Alzheimer’s disease (AD) developed a REM sleep behaviour disorder (RBD) during treatment with rivastigmine. The man, who had started sleep talking about 8 years earlier, presented with AD and started receiving rivastigmine 1.5mg twice daily in November 2008; the dosage was increased to 1.5mg in the morning and 3mg in the evening 1 month later. Soon after the dosage increase, he developed recurrent nocturnal parasomnic episodes. His family noted him leaving the bedroom and the house in the middle of the night; he experienced several falls during these episodes and sustained abrasions. The man’s evening rivastigmine dose was withdrawn and his parasomnias, including sleep shouting and peculiar behaviours, immediately resolved; occasional sleep talking persisted. In January 2009, worsening AD symptoms prompted re-initiation rivastigmine 1.5mg in the evening; he also started receiving an evening dose of clonazepam for presumed RBD. No parasomnias occurred, and his evening rivastigmine dose was increased to 3mg in February. Clonazepam was stopped the following month in preparation for polysomnography, and parasomnias (leaving the house, falls and abrasions) recurred during the first night. The following night, polysomnography showed episodes of bilateral arm waving with moaning and shouting during each REM period; all three episodes were followed by spontaneous awakening without recall of the preceding events. Author comment: "[T]his patient may have already developed subclinical RBD or mild RBD prior to rivastigmine therapy of AD, rendering him more vulnerable to RBD exacerbation by cholinergic therapy." Yeh SB, et al. Rivastigmine-induced REM sleep behavior disorder (RBD) in a 88-year-old man with Alzheimer’s disease. Journal of Clinical Sleep Medicine 6: 803021701 192-5, No. 2, 15 Apr 2010 - Taiwan
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Reactions 26 Jun 2010 No. 1307
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