Generic name: rivastigmine (oral) (ri va STIG meen)
Brand name: Exelon
Dosage forms: oral capsule (1.5 mg; 3 mg; 4.5 mg; 6 mg)
Drug class: Cholinesterase inhibitors
Rivastigmine is used to treat mild to moderate dementia caused by Alzheimer's or Parkinson's disease.
Rivastigmine is not a cure for Alzheimer's or Parkinson's disease.
Rivastigmine may also be used for purposes not listed in this medication guide.
Warnings
You should not take oral rivastigmine if you have ever had severe redness, itching, or skin irritation caused by wearing a rivastigmine transdermal skin patch.
Before taking this medicine
You should not take rivastigmine if you are allergic to rivastigmine or similar medicines, such as felbamate, meprobamate, or carisoprodol.
You should not take oral rivastigmine if you have ever had severe redness, itching, or skin irritation caused by wearing a rivastigmine transdermal skin patch.
Tell your doctor if you have ever had:
- an ulcer or stomach bleeding;
- a seizure;
- heart problems;
- liver or kidney disease;
- urination problems; or
- asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorder.
Tell your doctor if you are pregnant or plan to become pregnant.
It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.
How should I take rivastigmine?
Do not wear a rivastigmine transdermal skin patch at the same time you are taking rivastigmine capsules or oral liquid.
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
Take rivastigmine with food.
Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.
Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).
You may swallow the liquid medicine directly from the syringe or mix the medicine with a small glass of water, fruit juice, or soda. Stir and drink this mixture within 4 hours after mixing. Add a little more water to the glass, swirl gently and drink right away.
After using the syringe, wipe the outside of it with a clean tissue and put the syringe back into its protective case. Close the medicine bottle using the child-resistant closure.
Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking rivastigmine.
Rivastigmine doses are based on weight. Your dose needs may change if you gain or lose weight.
If you need surgery, tell your surgeon you currently use this medicine.
If you stop taking rivastigmine for any reason, do not restart the medicine without talking to your doctor first. You may need to start with a lower dose.
Store in an upright position at room temperature, away from moisture and heat. Do not allow the liquid medicine to freeze.
What happens if I miss a dose?
Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.
If you miss several doses in a row, call your doctor before taking any more of rivastigmine.
Get your prescription refilled before you run out of medicine completely.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include severe nausea, vomiting, salivation, sweating, slow heartbeats, weak or shallow breathing, fainting, or seizure (convulsions).
What should I avoid while taking rivastigmine?
Avoid driving or hazardous activity until you know how rivastigmine will affect you. Your reactions could be impaired.
Rivastigmine side effects
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
- severe or ongoing vomiting or diarrhea, loss of appetite, weight loss;
- bloody or tarry stools, cough with bloody mucus or vomit that looks like coffee grounds;
- a light-headed feeling, like you might pass out;
- tremors (uncontrolled shaking), restless muscle movements in your eyes, tongue, jaw, or neck;
- seizure (convulsions);
- painful or difficult urination;
- severe skin redness, itching, or irritation; or
- dehydration symptoms--feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin.
Common side effects may include:
- upset stomach, nausea, vomiting;
- loss of appetite; or
- weakness.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Rivastigmine dosing information
Usual Adult Dose for Alzheimer's Disease:
MILD TO MODERATE ALZHEIMER'S DISEASE:
ORAL:
-Initial dose: 1.5 mg orally twice a day
-Maintenance dose: After a minimum of 2 weeks of treatment, if the initial dosage is well tolerated, it can be increased to 3 mg twice a day; subsequent increases to 4.5 mg and 6 mg twice a day should be attempted only after a minimum of 2 weeks at the previous dosage
TRANSDERMAL PATCH:
-Initial Dose: 4.6 mg/24 hour patch applied to the skin once daily
-Maintenance Dose: After a minimum of 4 weeks of treatment at the initial dose, and if well tolerated, the dose can be increased to 9.5 mg/24 hours for as long as this dose is beneficial; the dose can then be increased to 13.3 mg/24 hours
-Maximum Dose: 13.3 mg/24 hour patch applied to skin daily; higher doses confer no appreciable additional benefit, and are associated with significant increase in the incidence of adverse events
SEVERE ALZHEIMER'S DISEASE:
TRANSDERMAL PATCH:
-Recommended dose: 13.3 mg/24 hours transdermal patch applied to skin once daily; replace with a new patch every 24 hours
Use: For the treatment of mild, moderate, or severe dementia of the Alzheimer's type (AD)
Usual Adult Dose for Parkinson's Disease:
MILD TO MODERATE PARKINSON'S DISEASE DEMENTIA:
ORAL:
Initial dose: 1.5 mg orally twice a day with morning and evening meals
Maintenance dose: Subsequently, the dose can be increased to 3 mg orally twice a day and further to 4.5 mg twice a day and 6 mg twice a day (based on tolerability) with a minimum of 4 weeks at each dose
TRANSDERMAL PATCH:
Initial dose: 4.6 mg/24 hours applied to the skin once a day
Maintenance dose: After a minimum of four weeks of treatment and if well tolerated, the dose of the patch can be increased to 9.5 mg/24 hours for as long as this dose is beneficial. The dose can then be increased to 13.3 mg/24 hours.
Maximum dose: 13.3 mg/24 hours. Higher doses confer no appreciable additional benefit, and are associated with significant increase in the incidence of adverse events.
Use: For the treatment of mild to moderate dementia associated with Parkinson's disease
What other drugs will affect rivastigmine?
Tell your doctor about all your other medicines, especially:
- medicine to treat depression, anxiety, mood disorders, or mental illness;
- cold or allergy medicine (Benadryl and others);
- beta blocker heart or blood pressure medication;
- medicine to treat Parkinson's disease;
- medicine to treat nausea/vomiting, stomach problems, motion sickness, or irritable bowel syndrome;
- medicine to treat overactive bladder;
- bronchodilator asthma medication; or
- an NSAID (nonsteroidal anti-inflammatory drug such as aspirin, ibuprofen, naproxen, Advil, Motrin, Aleve, and others.
This list is not complete and many other drugs may affect rivastigmine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.