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Rivastigmine Side Effects

In Summary

Commonly reported side effects of rivastigmine include: headache, abdominal pain, diarrhea, nausea, vomiting, weight loss, dizziness, and anorexia. Other side effects include: anxiety, drowsiness, tremor, fatigue, dizziness, dyspepsia, headache, weakness, depression, abdominal pain, anorexia, flatulence, diaphoresis, and malaise. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to rivastigmine: oral capsule, oral solution

As well as its needed effects, rivastigmine may cause unwanted side effects that require medical attention.

Severity: Major

If any of the following side effects occur while taking rivastigmine, check with your doctor immediately:

More common:
  • Diarrhea
  • indigestion
  • loss of appetite
  • loss of strength
  • nausea and vomiting
  • weight loss
Less common:
  • Fainting
  • Aggression
  • convulsions (seizures)
  • trembling and shaking of the hands and fingers
  • trouble urinating
Incidence not known:
  • Bloody or black, tarry stools
  • chest pain or discomfort
  • constipation
  • difficulty with speaking
  • drooling
  • lightheadedness, dizziness, or fainting
  • loss of balance control
  • muscle trembling, jerking, or stiffness
  • restlessness
  • severe stomach pain
  • shortness of breath
  • shuffling walk
  • slow or irregular heartbeat
  • stiffness of the limbs
  • trouble urinating
  • twisting movements of the body
  • uncontrolled movements, especially of the face, neck, and back
  • unusual tiredness
  • vomiting of blood or material that looks like coffee grounds

If any of the following symptoms of overdose occur while taking rivastigmine, get emergency help immediately:

Symptoms of overdose:
  • Chest pain or discomfort
  • increased sweating
  • increased watering of the mouth
  • irregular, fast, slow, or shallow breathing
  • lightheadedness, dizziness, or fainting
  • nausea (severe)
  • pale or blue lips, fingernails, or skin
  • seizures
  • slow or irregular heartbeat
  • trouble breathing
  • unusual tiredness
  • vomiting (severe)

Severity: Minor

Some rivastigmine side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:
  • Abdominal or stomach pain or cramping
  • bloated or full feeling
  • confusion
  • dizziness
  • headache
  • mental depression
  • seeing, hearing, or feeling things that are not there
  • trouble sleeping
Less common:
  • General feeling of discomfort or illness
  • runny nose

For Healthcare Professionals

Applies to rivastigmine: oral capsule, oral solution, transdermal film extended release


When treatment is interrupted for longer than several days, treatment must be reinitiated with the lowest daily dose to reduce the possibility of severe vomiting and its potentially serious sequelae.[Ref]

Gastrointestinal effects including nausea (47%), vomiting (31%), diarrhea (19%), anorexia (17%), abdominal pain (13%), dyspepsia (9%), constipation (5%), flatulence (4%), and eructation (2%) have been reported. There has also been one postmarketing report of severe vomiting with esophageal rupture following inappropriate reinitiation of treatment. Postmarketing reports have included duodenal ulcers.[Ref]

Nervous system

Nervous system side effects including dizziness (21%), headache (17%), somnolence (5%), tremor (4%), increased sweating (4%), and syncope (3%) have been reported. Postmarketing reports have included confusion.[Ref]


General side effects including accidental trauma (10%), fatigue (9%), asthenia (6%), malaise (5%), influenza-like symptoms (3%), and decreased weight (3%) have been reported.[Ref]


Psychiatric side effects including insomnia (9%), confusion (8%), depression (6%), anxiety (5%), hallucination (4%), and aggressive reaction (3%) have been reported.[Ref]


Dermatologic side effects including Stevens-Johnson syndrome have been reported. A case of erythematous macropapular eruption due to rivastigmine therapy has also been reported. Postmarketing side effects have included reports of disseminated cutaneous hypersensitivity reactions.[Ref]


Genitourinary side effects including urinary tract infection (7%) have been reported.[Ref]


Respiratory side effects including rhinitis (4%) have been reported.[Ref]


Cardiovascular side effects including hypertension (3%) have been reported. A case of complete atrioventricular block has also been reported.[Ref]


Hepatic side effects have included abnormal liver function tests.


1. "Product Information. Exelon (rivastigmine)" Novartis Pharmaceuticals, East Hanover, NJ.

2. Monastero R, Lopez G, Mannino M, Camarda R "Erythematous maculopapular eruption due to rivastigmine therapy." Am J Med 111 (2001): 583-4

3. Kayrak M, Yazici M, Ayhan SS, Koc F, Ulgen MS "Complete atrioventricular block associated with rivastigmine therapy." Am J Health Syst Pharm 65 (2008): 1051-3

It is possible that some side effects of rivastigmine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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