Rivastigmine Dosage
This dosage information may not include all the information needed to use Rivastigmine safely and effectively. See additional information for Rivastigmine.
The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.
Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Alzheimer's Disease
Initial Oral Dose: 1.5 mg orally twice a day with morning and evening meals.
After a minimum of two weeks of treatment, if the initial dosage is well tolerated, it may 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. The dosage of rivastigmine shown to be effective in controlled clinical trials is 3 to 6 mg twice a day. There is evidence from the clinical trials that dosages at the higher end of this range may be more beneficial.
Initial Patch Dose: 4.6 mg/24 hours
After a minimum of four weeks of treatment and if well tolerated, the dose of the patch be increased to 9.5 mg/24 hours, which is the recommended effective dose.
Maintenance Patch Dose: Dose increases should occur only after a minimum of four weeks at the previous dose, and only if the previous dose has been well tolerated. The maximum recommended dose is 9.5 mg/ 24 hours. Higher doses confer no appreciable additional benefit, and are associated with significant increase in the incidence of adverse events.
Switching from Capsules or Oral Solution: Patients treated with capsules or oral solution may be switched to patches as follows:
A patient who is on a total daily dose of less than 6 mg of oral rivastigmine can be switched to patch dose of 4.6 mg/24 hours.
A patient who is on a total daily dose of 6 to 12 mg of oral rivastigmine may be directly switched to a patch dose of 9.5 mg/24 hours.
It is recommended to apply the first patch on the day following the last oral dose.
Usual Adult Dose for Parkinson's Disease
Initial dose: 1.5 mg orally twice a day with morning and evening meals
Subsequently, the dose may 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.
Initial Patch Dose: 4.6 mg/24 hours
After a minimum of four weeks of treatment and if well tolerated, the dose of the patch be increased to 9.5 mg/24 hours, which is the recommended effective dose.
Maintenance Patch Dose: Dose increases should occur only after a minimum of four weeks at the previous dose, and only if the previous dose has been well tolerated. The maximum recommended dose is 9.5 mg/ 24 hours. Higher doses confer no appreciable additional benefit, and are associated with significant increase in the incidence of adverse events.
Switching from Capsules or Oral Solution: Patients treated with capsules or oral solution may be switched to patches as follows:
A patient who is on a total daily dose of less than 6 mg of oral rivastigmine can be switched to patch dose of 4.6 mg/24 hours.
A patient who is on a total daily dose of 6 to 12 mg of oral rivastigmine may be directly switched to a patch dose of 9.5 mg/24 hours.
It is recommended to apply the first patch on the day following the last oral dose.
Renal Dose Adjustments
Data not available.
Liver Dose Adjustments
Data not available.
Dose Adjustments
If adverse effects (e.g., nausea, vomiting, abdominal pain, loss of appetite) cause intolerance during treatment, the patient should be instructed to discontinue treatment for several doses and then restart at the same or next lower dosage level. If treatment is interrupted for longer than several days, it should be reinitiated with the lowest daily dose and then titrated up.
Precautions
Rivastigmine may increase gastric acid secretion due to increased cholinergic activity. Careful monitoring for symptoms of gastrointestinal bleeding is recommended, especially in patients who may be at increased risk for developing ulcers.
Rivastigmine can have vagotonic effects on heart rate (e.g., bradycardia), on the bladder (e.g., urinary obstruction), and on the nervous system (e.g., increased likelihood of seizures).
Caution is recommended if rivastigmine is used in patients with a history of asthma or obstructive pulmonary disease.
Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).
Dialysis
Data not available.
Other Comments
Patches should be applied once a day to clean, dry, hairless, intact healthy skin in a place that will not be rubbed against by tight clothing. The upper or lower back is recommended as the site of application because the patch is less likely to be removed by the patient; however, when sites on the back are not accessible the patch can be applied to the upper arm or chest. The patch should not be applied to skin that is red, irritated, or cut. The site of patch application should be changed daily to avoid potential irritation, although consecutive patches can be applied to the same anatomic site (e.g., another spot on the upper back). The same site should not be used within 14 days. The patch should be pressed down firmly until the edges stick well. The patch can be used in situations that include bathing and hot weather. The patch should be replaced with a new one every 24 hours. Patients and caregivers should be instructed accordingly.
To prevent interference with the adhesive properties of the patch, the patch should not be applied to a skin area where cream, lotion or powder has recently been applied.
