Generic Name: rivastigmine (ri va STIG meen)
Brand Names: Exelon

What is Exelon?

Exelon (rivastigmine) improves the function of nerve cells in the brain. It works by preventing the breakdown of a chemical that is important for the processes of memory, thinking, and reasoning. People with dementia usually have lower levels of this chemical.

Exelon is used to treat mild to moderate dementia caused by Alzheimer's or Parkinson's disease.

Exelon may also be used for purposes not listed in this medication guide.

Important information

Exelon may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

You should not take oral Exelon if you have ever had severe redness, itching, or skin irritation caused by wearing a Exelon skin patch.

Slideshow: Flashback: FDA Drug Approvals 2013

Call your doctor at once if you have severe or ongoing vomiting or diarrhea, loss of appetite, weight loss, heavy sweating or hot and dry skin, black or bloody stools, coughing up blood, tremors (uncontrolled shaking), or restless muscle movements in your eyes, tongue, jaw, or neck.

Before using Exelon, tell your doctor if you have liver disease, a heart rhythm disorder such as "sick sinus syndrome" (slow heartbeats), recent weight loss or lack of appetite, an enlarged prostate, urination problems, a seizure disorder, asthma or allergies, tremors or uncontrolled muscle movements, or a history of stomach ulcer.

Always remove an old patch before putting on a new one. Do not wear more than one Exelon skin patch at a time.

Before taking this medicine

You should not take Exelon if you are allergic to rivastigmine or similar medicines, such as neostigmine, meprobamate, or carisoprodol.

To make sure Exelon is safe for you, tell your doctor if you have:

  • liver or kidney disease;

  • recent weight loss or lack of appetite;

  • a heart rhythm disorder such as "sick sinus syndrome" (slow heartbeats);

  • an enlarged prostate or urination problems;

  • epilepsy or other seizure disorder;

  • asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorder;

  • a history of stomach ulcer; or

  • tremors (dyskinesia) or uncontrolled muscle movements.

FDA pregnancy category B. Exelon is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

See also: Pregnancy and breastfeeding warnings (in more detail)

It is not known whether rivastigmine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How should I take Exelon?

Exelon is usually taken twice per day. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take Exelon with food.

Exelon oral solution (liquid) comes with patient instructions for correctly measuring the dose. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

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 the mixture and drink all of it within 4 hours after mixing. To get the entire dose, add a little more water to the same 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.

Use Exelon regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Tell your doctor if you have any changes in weight. Exelon doses are based on weight, and any changes may affect the dose.

If you need surgery, tell the surgeon ahead of time that you are using Exelon. You may need to stop using the medicine for a short time.

If you stop taking Exelon for any reason, do not restart the medicine without talking to your doctor first. You may need to restart treatment 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.

Exelon dosing information

Usual Adult Dose of Exelon for Alzheimer's Disease:

Mild to moderate Alzheimer's Disease:
Oral:
Initial dose: 1.5 mg orally twice a day with morning and evening meals.
Maintenance dose: 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.
Transdermal:
Initial Dose: 4.6 mg/24 hour transdermal patch applied to the skin once daily
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 hour transdermal patch applied to skin daily. Higher doses confer no appreciable additional benefit, and are associated with significant increase in the incidence of adverse events.
Comment:
-Apply once a day
-Press down firmly for 30 seconds until edges stick well
-Use upper or lower back as the site of application
-Do not apply to skin area where cream, lotion, powder has been recently applied
-Do not apply to skin that is red, irritated, or cut
-Wear one patch at a time
-Change site of application daily, do not apply a new patch to same location for at least 14 days
-May wear patch during bathing, but avoid long exposure to external heat sources

Severe Alzheimer's Disease:
13.3 mg/24 hours transdermal patch applied to skin once daily; replace with a new patch every 24 hours
Comment:
-If dosing interrupted for 3 days or fewer, restart treatment with the same or lower strength transdermal patch
-If dosing is interrupted for more than 3 days, restart treatment with the 4.6 mg/24 hours transdermal patch and titrate

Usual Adult Dose of Exelon 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 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.

Transdermal:
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 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.
Comment:
-Apply once a day
-Press down firmly for 30 seconds until edges stick well
-Use upper or lower back as the site of application
-Do not apply to skin area where cream, lotion, powder has been recently applied
-Do not apply to skin that is red, irritated, or cut
-Wear one patch at a time
-Change site of application daily, do not apply a new patch to same location for at least 14 days
-May wear patch during bathing, but avoid long exposure to external heat sources

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

If you miss several doses in a row, call your doctor before taking any more of this medicine.

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 Exelon?

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Exelon side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Exelon: 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 with weight loss;

  • bloody or tarry stools, coughing up blood 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

  • if you feel very thirsty or hot, are unable to urinate, and have heavy sweating or hot and dry skin.

Common Exelon side effects may include:

  • nausea, vomiting, upset stomach;

  • 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.

See also: Side effects (in more detail)

What other drugs will affect Exelon?

Do not wear a Exelon skin patch at the same time you are taking Exelon capsules or oral liquid.

Other drugs may interact with rivastigmine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about Exelon.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Exelon only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2014 Cerner Multum, Inc. Version: 5.01. Revision Date: 2014-05-30, 4:12:53 PM.

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