Rivastigmine for Delirium

(RIVA-AM Trial)

This trial tests rivastigmine to determine its effectiveness in treating antimuscarinic delirium, a type of confusion and agitation caused by certain poisons. Since the usual treatment, physostigmine, is difficult to obtain, researchers aim to assess whether rivastigmine can serve as a suitable alternative. Participants will receive either rivastigmine or a placebo (a pill with no active drug) to evaluate which better alleviates symptoms. This trial suits individuals diagnosed with antimuscarinic delirium who experience significant confusion and agitation. As a Phase 2 trial, the research focuses on measuring the treatment's effectiveness in an initial, smaller group of people.

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial team or your doctor.

Research has shown that rivastigmine is generally safe for use. In other studies, some patients taking rivastigmine experienced common side effects such as nausea, vomiting, and dizziness, which were usually mild. Rivastigmine has also been used in patients with Alzheimer's disease, providing insights into its safety. However, using rivastigmine for antimuscarinic delirium (AMD) remains under investigation, so more research is needed to fully understand its safety and effectiveness for this condition.¹²³⁴⁵

Rivastigmine is unique because it targets delirium through a mechanism that is different from standard treatments like antipsychotics and benzodiazepines. Most current options focus on calming symptoms, but Rivastigmine works by enhancing communication between nerve cells in the brain, potentially addressing the root cause of delirium. Researchers are excited about Rivastigmine because it offers a possibility for more rapid symptom control and may reduce the need for sedative medications, which often come with side effects. This approach could lead to better outcomes for patients experiencing delirium, which is a common and challenging condition in hospitals.

Research has shown that rivastigmine, a type of medication, can improve thinking and reduce restlessness in people with mild to moderate Alzheimer’s disease. This suggests potential benefits for antimuscarinic delirium (AMD), a condition marked by confusion and agitation. Some small studies and reports have indicated that rivastigmine could alleviate AMD symptoms. In this trial, participants in the rivastigmine arm will receive rivastigmine to assess its effectiveness for ongoing delirium or agitation. Although it hasn't been directly compared to the usual treatment, physostigmine, rivastigmine's ability to enhance cognition and calm agitation makes it a promising option for treating AMD.⁵⁶⁷⁸⁹