Lower Extremity Tremor Exacerbation due to Rivastigmine Administration for Treatment of Parkinson’s Disease Dementia

Rivastigmine is one of the approved effective treatments for Parkinson's Disease Dementia (PDD). Increase of upper extremity resting tremor is a common adverse effect seen in patients administered rivastigmine and is usually mild, not leading to treatment withdrawal. Rivastigmine patch was given to both of our patients diagnosed with PDD and they suffered from postural instability and lower extremity tremor that occurred while standing and disappeared with walking after the administration and increase dosage of the drug in a few months time. The lower extremity tremor disappeared markedly in both patients after the dose reduction. Disabling lower extremity tremor due to rivastigmine dosage increase has not been reported before. We want to draw attention to this rare side effect through these patients and mention not to quit the drug.