{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:08:21Z","timestamp":1777417701731,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2002,10,1]],"date-time":"2002-10-01T00:00:00Z","timestamp":1033430400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2002,10]]},"abstract":"\n OBJECTIVE:<\/jats:title>\n To report a case of fatal aspiration pneumonia in a patient shortly after initiation of rivastigmine and discontinuation of donepezil, with no washout period between therapies.<\/jats:p>\n <\/jats:sec>\n \n CASE SUMMARY:<\/jats:title>\n \n An 83-year-old white man presented to the emergency department in respiratory distress (O\n 2<\/jats:sub>\n saturation 70%; RR 44 breaths\/min) secondary to aspiration. He had started rivastigmine 1.5 mg twice daily that same day. The patient had been previously treated with donepezil 10 mg\/d, and there was no washout period. He was intubated due to worsening respiratory status and was transferred to the cardiac care unit. He then became hypotensive and required dopamine and fluid support. Brief bronchoscopy revealed food particles in the lower airways and bile-stained secretions. Intubation was notable for the large amount of secretions. The patient died approximately 27 hours after presentation to the emergency department. Blood and sputum cultures were subsequently positive for Haemophilus influenzae.\n <\/jats:p>\n <\/jats:sec>\n \n DISCUSSION:<\/jats:title>\n Cholinesterase (ChE) inhibitors approved for treatment of Alzheimer disease are associated with nausea and vomiting in a sizable percentage of patients, ranging from 5% to 31% in clinical trials. Most of these adverse events occur during the initiation\/titration phase of therapy. An additive risk of adverse events may be expected with coadministration of ChE inhibitors or cholinergic agents or, potentially, with an inadequate washout period between such agents. Review of MEDLINE (1966\u2013July 2002) and International Pharmaceutical Abstracts (1970\u2013July 2002) failed to identify any previous reports of aspiration with rivastigmine or donepezil.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n A washout period should be considered when switching between ChE inhibitors to minimize the risk of vomiting and aspiration.<\/jats:p>\n <\/jats:sec>","DOI":"10.1345\/aph.1c036","type":"journal-article","created":{"date-parts":[[2003,6,4]],"date-time":"2003-06-04T16:06:13Z","timestamp":1054742773000},"page":"1550-1553","source":"Crossref","is-referenced-by-count":11,"title":["Fatal Aspiration Pneumonia during Transition from Donepezil to Rivastigmine"],"prefix":"10.1177","volume":"36","author":[{"given":"Amy M","family":"Taylor","sequence":"first","affiliation":[{"name":"Amy M Taylor PharmD, at time of writing, Pharmacy Resident, College of Pharmacy, University of Iowa, Iowa City, and Northeast Iowa Family Practice Residency Program, Waterloo, IA; now, Clinical Pharmacist, Allen Memorial Hospital, Waterloo, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James D","family":"Hoehns","sequence":"additional","affiliation":[{"name":"James D Hoehns PharmD BCPS, Assistant Professor (Clinical), College of Pharmacy, University of Iowa; Clinical Pharmacist, Northeast Iowa Family Practice Residency Program"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doris M","family":"Anderson","sequence":"additional","affiliation":[{"name":"Doris M Anderson BSPharm, at time of writing, PharmD Student, University of Iowa; now, Administrative Director of Pharmacy, Covenant Health System, Waterloo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daren G","family":"Tobert","sequence":"additional","affiliation":[{"name":"Daren G Tobert MD FCCP, Medical Director, Intensive Care Unit, Covenant Medical Center, Waterloo"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2002,10,1]]},"reference":[{"key":"bibr-bibr1-aph.1C036","first-page":"954e","volume-title":"Drug facts and comparisons","year":"2001"},{"key":"bibr-bibr2-aph.1C036","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200103013440908"},{"key":"bibr-bibr3-aph.1C036","first-page":"428","volume-title":"Cecil textbook of medicine","author":"Piantadosi C","year":"2000"},{"key":"bibr-bibr4-aph.1C036","doi-asserted-by":"publisher","DOI":"10.1159\/000052811"},{"key":"bibr-bibr5-aph.1C036","first-page":"439","volume-title":"Cecil textbook of medicine","author":"Finegold S","year":"2000"},{"key":"bibr-bibr6-aph.1C036","first-page":"1137","volume":"16","author":"Daiello L","year":"2001","journal-title":"Consultant Pharm"},{"key":"bibr-bibr7-aph.1C036","doi-asserted-by":"publisher","DOI":"10.1016\/S0149-2918(01)80166-1"},{"key":"bibr-bibr8-aph.1C036","volume-title":"Galantamine: a new agent for the treatment of Alzheimer's disease","author":"Phillips J","year":"2001"},{"key":"bibr-bibr9-aph.1C036","unstructured":"Sohn H, Danyluk J, Hasrman R, Anand R, Wilkinson D. Safety of initiating rivastigmine therapy after donepezil therapy (abstract P-509R). Presented at: The American Society of Health-System Pharmacists Midyear Clinical Meeting, Las Vegas, December 1\u20135, 2000."},{"key":"bibr-bibr10-aph.1C036","unstructured":"Shua-Haim JR, Smith JM, Amin S. Results of a one-week overlap-crossover study of donepezil (Aricept) to rivastigmine (Exelon) in Alzheimer's disease patients: a one-month prospective study (poster P-200). Presented at: the American Geriatrics Society Annual Scientific Meeting, Chicago, May 9\u201313, 2001."},{"key":"bibr-bibr11-aph.1C036","unstructured":"Shua-Haim JR, Smith JM, Amin S. Crossover results of donepezil (Aricept) to rivastigmine (Exelon) in Alzheimer's disease patients: a two-month prospective study (poster P-201). Presented at: the American Geriatrics Society Annual Scientific Meeting, Chicago, May 9\u201313, 2001."},{"key":"bibr-bibr12-aph.1C036","unstructured":"Edwards KR, Goodman W, Khoury KN, Norton J, Cross N, Lewis C, Rapid changeover from donepezil to rivastigmine well tolerated (poster P-251). Presented at: the American Geriatrics Society Annual Scientific Meeting, Chicago, May 9\u201313, 2001."},{"key":"bibr-bibr13-aph.1C036","volume-title":"Exelon (rivastigmine)","year":"2001"},{"key":"bibr-bibr14-aph.1C036","volume-title":"Aricept (donepezil)","year":"2000"},{"key":"bibr-bibr15-aph.1C036","volume-title":"Reminyl (galantamine)","year":"2001"},{"key":"bibr-bibr16-aph.1C036","doi-asserted-by":"publisher","DOI":"10.1177\/153331750001500408"},{"key":"bibr-bibr17-aph.1C036","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"}],"container-title":["Annals of Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.1C036","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.1C036","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:05:34Z","timestamp":1777374334000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1345\/aph.1C036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,10]]},"references-count":17,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2002,10]]}},"alternative-id":["10.1345\/aph.1C036"],"URL":"https:\/\/doi.org\/10.1345\/aph.1c036","relation":{},"ISSN":["1060-0280","1542-6270"],"issn-type":[{"value":"1060-0280","type":"print"},{"value":"1542-6270","type":"electronic"}],"subject":[],"published":{"date-parts":[[2002,10]]}}}