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rivastigmine

Pronunciation

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

What is rivastigmine?

Rivastigmine improves the function of nerve cells in the brain. It works by preventing the breakdown of a chemical called acetylcholine (ah see til KO leen). People with dementia usually have lower levels of this chemical, which is important for the processes of memory, thinking, and reasoning.

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

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

What is the most important information I should know about rivastigmine?

Before taking rivastigmine, tell your doctor if you have a heart rhythm disorder such as "sick sinus syndrome" (slow heartbeats), an enlarged prostate, urination problems, asthma, obstructive pulmonary disease, or a seizure disorder such as epilepsy.

Stop using rivastigmine and call your doctor at once if the medicine causes you to have stomach pain, nausea and vomiting, and loss of appetite.

Slideshow: Flashback: FDA Drug Approvals 2013

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

It is important to use rivastigmine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

If you stop taking rivastigmine for any reason, do not restart the medication without talking to your doctor first. You may need to restart treatment with a lower dose.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking rivastigmine.

Rivastigmine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What should I discuss with my healthcare provider before taking rivastigmine?

Before taking rivastigmine, tell your doctor if you have:

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

  • an enlarged prostate or urination problems;

  • epilepsy or other seizure disorder; or

  • asthma or obstructive pulmonary disease.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take rivastigmine.

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

It is not known whether rivastigmine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take rivastigmine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Rivastigmine is usually taken twice a day, in the morning and evening. Follow your doctor's directions.

Take rivastigmine with food.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking rivastigmine. You may need to stop using the medicine for a short time.

Take the rivastigmine capsule with a full glass of water.

Do not use a regular table spoon to measure a dose of rivastigmine oral liquid (solution). Use the syringe provided.

You may swallow the oral liquid directly from the syringe or mix the medicine with a small glass of water, fruit juice, or soda. Do not use any other liquids to mix with rivastigmine oral liquid.

Stir the medicine mixture and drink all of it right away. To make sure you 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 case. Close the medicine bottle using the child resistant closure.

It is important to use rivastigmine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

If you stop taking rivastigmine for any reason, do not restart the medication without talking to your doctor first. You may need to restart treatment with a lower dose.

Store rivastigmine at room temperature away from moisture and heat in an upright position.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. 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 medication.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include severe nausea, vomiting, drooling, sweating, blurred vision, feeling light-headed, slow heartbeat, shallow breathing, muscle weakness, fainting, or seizure (convulsions).

What should I avoid while taking rivastigmine?

Rivastigmine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Rivastigmine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using rivastigmine and call your doctor at once if you have any of these serious side effects:

  • stomach pain, nausea and vomiting, loss of appetite;

  • black, bloody, or tarry stools;

  • coughing up blood or vomit that looks like blood or coffee grounds;

  • feeling light-headed, fainting;

  • chest pain;

  • confusion, agitation, extreme fear; or

  • pain or burning when you urinate.

Less serious side effects may include:

  • upset stomach, diarrhea;

  • weight loss;

  • weakness, dizziness;

  • swelling in your hands or feet;

  • joint pain;

  • cough, runny or stuffy nose;

  • increased sweating;

  • sleep problems (insomnia); or

  • headache.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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 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 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 other drugs will affect rivastigmine?

Before taking rivastigmine, tell your doctor if you are using any of the following drugs:

  • atropine (Donnatal, and others);

  • belladonna;

  • clidinium (Quarzan);

  • dicyclomine (Bentyl);

  • glycopyrrolate (Robinul);

  • hyoscyamine (Anaspaz, Cystospaz, Levsin, and others);

  • mepenzolate (Cantil);

  • methantheline (Provocholine);

  • methscopolamine (Pamine);

  • propantheline (Pro-Banthine); or

  • scopolamine (Transderm-Scop).

This list is not complete and there may be other drugs that can interact with rivastigmine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about rivastigmine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication 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 1996-2012 Cerner Multum, Inc. Version: 4.06. Revision Date: 2010-12-15, 5:01:39 PM.

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