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EMERPAND 4.6MG/24H TRANSDERMAL PATCHES

Active substance(s): RIVASTIGMINE

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Package leaflet: Information for the user
Emerpand 4.6mg/24h, 9.5mg/24h and 13.3mg/24h Transdermal Patches
Rivastigmine
Read all of this leaflet carefully before you start using this medicine because it contains
important information for you.
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor, pharmacist or nurse.
This medicine has been prescribed for you only. Do not pass it on to others. It may harm them,
even if their signs of illness are the same as yours.
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible
side effects not listed in this leaflet. See section 4.
What is in this leaflet
1.
What Emerpand is and what it is used for
2.
What you need to know before you use Emerpand
3.
How to use Emerpand
4.
Possible side effects
5.
How to store Emerpand
6.
Contents of the pack and other information

1.

What Emerpand is and what it is used for

The active substance of Emerpand is rivastigmine.
Rivastigmine belongs to a class of substances called cholinesterase inhibitors. In patients with
Alzheimer’s dementia, certain nerve cells die in the brain, resulting in low levels of the
neurotransmitter acetylcholine (a substance that allows nerve cells to communicate with each other).
Rivastigmine works by blocking the enzymes that break down acetylcholine: acetylcholinesterase and
butyrylcholinesterase. By blocking these enzymes, Emerpand allows levels of acetylcholine to be
increased in the brain, helping to reduce the symptoms of Alzheimer’s disease.
Emerpand is used for the treatment of adult patients with mild to moderately severe Alzheimer’s
dementia, a progressive brain disorder that gradually affects memory, intellectual ability and
behaviour.

2.

What you need to know before you use Emerpand

Do not use Emerpand
if you are allergic to rivastigmine or any of the other ingredients of this medicine (listed in
section 6).
if you have ever had an allergic reaction to a similar type of medicine (carbamate derivatives).
if you have a skin reaction spreading beyond the patch size, if there is a more intense local
reaction (such as blisters, increasing skin inflammation, swelling) and if it does not improve
within 48 hours after removal of the transdermal patch.
If this applies to you, tell your doctor and do not apply Emerpand transdermal patches.
Warnings and precautions
Talk to your doctor before using Emerpand:
if you have, or have ever had, an irregular heartbeat.
if you have, or have ever had, an active stomach ulcer.
if you have, or have ever had, difficulties in passing urine.
if you have, or have ever had, seizures.
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if you have, or have ever had, asthma or a severe respiratory disease.
if you suffer from trembling.
if you have a low body weight.
if you have gastrointestinal reactions such as feeling sick (nausea), being sick (vomiting) and
diarrhoea. You may become dehydrated (losing too much fluid) if vomiting or diarrhoea are
prolonged.
if you have impaired liver function.
If any of these apply to you, your doctor may need to monitor you more closely while you are on this
medicine.
If you have not applied a patch for several days, do not apply the next one before you have talked to
your doctor.
Use in children and adolescents
There is no relevant use of Emerpand in the paediatric population in the treatment of Alzheimer’s
disease.
Other medicines and Emerpand
Please tell your doctor or pharmacist if you are taking, have recently taken or might take any other
medicines.
Emerpand might interfere with anticholinergic medicines some of which are medicines used to relieve
stomach cramps or spasms (e.g. dicyclomine), to treat Parkinson’s disease (e.g. amantadine) or to
prevent motion sickness (e.g. diphenhydramine, scopolamine or meclizine).
If you have to undergo surgery whilst using Emerpand transdermal patches, tell your doctor that you
are using them because they may exaggerate the effects of some muscle relaxants during anaesthesia.

Pregnancy, breast feeding and fertility
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask
your doctor or pharmacist for advice before taking this medicine.
If you are pregnant, the benefits of using Emerpand transdermal patches must be assessed against the
possible effects on your unborn child. Emerpand should not be used during pregnancy unless clearly
necessary.
You should not breast-feed during treatment with Emerpand transdermal patches.
Driving and using machines
Your doctor will tell you whether your illness allows you to drive vehicles and use machines safely.
Emerpand transdermal patches may cause fainting or severe confusion. If you feel faint or confused do
not drive, use machines or perform any other tasks that require your attention.
Emerpand contains butylated hydroxytoluene
May cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes and mucous
membranes.
3.

How to use Emerpand

Always use this medicine exactly as described in this leaflet and as your doctor has told you. Check
with your doctor, pharmacist or nurse if you are not sure.
IMPORTANT:
Take off the previous patch before putting ONE new patch on.
Only one patch per day.
Do not cut the patch into pieces.
Press the patch firmly in place for at least 30 seconds using the palm of the hand.
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How to start treatment
Your doctor will tell you which Emerpand transdermal patch is most suitable for you.
Treatment usually starts with Emerpand 4.6mg/24h.
The recommended daily dose is Emerpand 9.5mg/24h. If well tolerated, the treating physician
may consider increasing the dose to 13.3mg/24h.
Only wear one Emerpand patch at a time and replace the patch with a new one after 24 hours.
During the course of the treatment your doctor may adjust the dose to suit your individual needs.
If you have not applied a patch for three days, do not apply the next one before you have talked to
your doctor. Transdermal patch treatment can be resumed at the same dose if treatment is not
interrupted for more than three days. Otherwise your doctor will restart your treatment on Emerpand
4.6mg/24h.
Emerpand can be used with food, drink and alcohol.
Where to apply your Emerpand transdermal patch
Before you apply a patch, make sure that your skin is clean, dry and hairless, free of any
powder, oil, moisturiser or lotion that could keep the patch from sticking to your skin properly,
free of cuts, rashes and/or irritations.
Carefully remove any existing patch before putting on a new one. Having multiple patches
on your body could expose you to an excessive amount of this medicine which could be
potentially dangerous.
Apply ONE patch per day to ONLY ONE of the possible locations shown in the following
diagrams:
Every 24 hours take off the previous patch before putting
ONE new patch on to ONLY ONE of the following possible
locations.


left upper arm or right upper arm



left upper chest or right upper chest (avoid breast)



left upper back or right upper back

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left lower back or right lower back

When changing the patch, you must remove the previous day’s patch before you apply the new one to
a different location of skin each time (for example on the right side of your body one day, then on the
left side the next day, and on your upper body one day, then on your lower body the next day). Do not
apply a new patch to the same skin area twice within 14 days.
How to apply your Emerpand transdermal patch
Emerpand patches are transparent to translucent, plastic patches that stick to the skin. Each patch is
sealed in a sachet that protects it until you are ready to put it on. Do not open the sachet or remove a
patch until just before you apply it.
Carefully remove the existing patch before putting on a new one.

For patients starting treatment for the first time and for patients
restarting Emerpand after treatment interruption, please begin
with the second picture.

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Each patch is sealed in its own protective sachet.
You should only open the sachet when you are ready to
apply the patch.
Tear the sachet open where indicated and remove the patch
from the sachet. The sachet can be torn open in two places.

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A protective liner covers the sticky side of the patch.
Peel off one half of the protective liner and do not touch the
sticky part of the patch with the fingers.

-

Put the sticky side of the patch on the upper or lower back,
upper arm or chest and then peel off the second half of the
protective liner.

-

Then press the patch firmly in place for at least 30 seconds
using the palm of the hand to make sure that the edges stick
well.

If it helps you, you may write, for example, the day of the week,
on the patch with a thin ball point pen.

The patch should be worn continuously until it is time to replace it with a new one. You may wish to
experiment with different locations when applying a new patch, to find ones that are most comfortable
for you and where clothing will not rub on the patch.
How to remove your Emerpand transdermal patch
Gently pull at one edge of the patch to remove it slowly from the skin. In case the adhesive residue is
left over on your skin, gently soak the area with warm water and mild soap or use baby oil to remove
it. Alcohol or other dissolving liquids (nail polish remover or other solvents) should not be used.
You should wash your hands with soap and water after removing the patch. In case of contact with
eyes or if the eyes become red after handling the patch, rinse immediately with plenty of water and
seek medical advice if symptoms do not resolve.
Can you wear your Emerpand transdermal patch when you are bathing, swimming, or in the
sun?
Bathing, swimming or showering should not affect the patch. Make sure the patch does not
loosen during these activities.
Do not expose the patch to any external heat sources (e.g. excessive sunlight, saunas, solarium)
for long periods of time.
What to do if a patch falls off
If a patch falls off, apply a new one for the rest of the day, then replace it at the same time as usual the
next day.
When and for how long to apply your Emerpand transdermal patch
To benefit from treatment, you must apply a new patch every day, preferably at the same time
of day.
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Only wear one Emerpand patch at a time and replace the patch with a new one after 24 hours.

If you use more Emerpand than you should
If you accidentally apply more than one patch, remove all the patches from your skin, then inform
your doctor that you have accidentally applied more than one patch. You may require medical
attention. Some people who have accidentally taken too much Emerpand have experienced feeling
sick (nausea), being sick (vomiting), diarrhoea, high blood pressure and hallucinations. Slow heartbeat
and fainting may also occur.
If you forget to use Emerpand
If you find you have forgotten to apply a patch, apply one immediately. You may apply the next patch
at the usual time the next day. Do not apply two patches to make up for the one that you missed.
If you stop using Emerpand
Tell your doctor or pharmacist if you stop using the patch.
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.
You may have side effects more often when you start your medicine or when your dose is increased.
Usually, the side effects will slowly go away as your body gets used to the medicine.
Take off your patch and tell your doctor straight away, if you notice any of the following side
effects which could become serious:
Common (may affect up to 1 in 10 people)
Loss of appetite
Feeling dizzy
Feeling agitated or sleepy
Urinary incontinence (inability to retain adequate urine)
Uncommon (may affect up to 1 in 100 people)
Problems with your heartbeat such as slow heartbeat
Seeing things that are not really there (hallucinations)
Stomach ulcer
Dehydration (losing too much fluid)
Hyperactivity (high level of activity, restlessness)
Aggression
Rare (may affect up to 1 in 1,000 people)
Falling
Very rare (may affect up to 1 in 10,000 people)
Stiff arms or legs
Trembling hands
Not known (frequency cannot be estimated from the available data)
Allergic reaction where the patch was used, such as blisters or inflamed skin
The signs of Parkinson’s disease get worse – such as tremor, stiffness and shuffling
Inflammation of the pancreas – signs include serious upper stomach pain, often with feeling sick
(nausea) or being sick (vomiting)
Fast or uneven heartbeat
High blood pressure
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Fits (seizures)
Liver disorders (yellow skin, yellowing of the whites of the eyes, abnormal darkening of the
urine or unexplained nausea, vomiting, tiredness and loss of appetite)
Changes in tests which show how well the liver is working
Feeling restless
Take off your patch and tell your doctor straight away, if you notice any of the side effects above.
Other side effects seen with Emerpand capsules or oral solution and which may occur with the
patch:
Common (may affect up to 1 in 10 people)
Too much saliva
Loss of appetite
Feeling restless
Generally feeling unwell
Trembling or feeling confused
Increased sweating
Uncommon (may affect up to 1 in 100 people)
Uneven heart rate (e.g. fast heart rate)
Difficulty sleeping
Accidental falls
Rare (may affect up to 1 in 1,000 people)
Fits (seizures)
Ulcer in the intestine
Chest pain – this may be caused by heart spasm
Very rare (may affect up to 1 in 10,000 people)
High blood pressure
Inflammation of the pancreas – the signs include serious upper stomach pain, often with feeling
sick (nausea) or being sick (vomiting)
Bleeding in the gut – shows as blood in stools or when being sick
Seeing things that are not there (hallucinations)
Some people who have been violently sick have had tearing of the tube that connects your
mouth with your stomach (oesophagus)
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side
effects not listed in this leaflet. You can also report side effects directly via
United Kingdom
Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard
Ireland
HPRA Pharmacovigilance, Earlsfort Terrace , IRL - Dublin 2
Tel: +353 1 6764971
Fax: +353 1 6762517
Website: www.hpra.ie
e-mail: medsafety@hpra.ie
By reporting side effects you can help provide more information on the safety of this medicine.

5.

How to store Emerpand

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Keep this medicine out of the sight and reach of children.
Do not use /this medicine after the expiry date, which is stated on the carton and sachet after
EXP. The expiry date refers to the last day of the month.
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This medicinal product does not require any special storage conditions.
Keep the transdermal patch in the sachet until use.
Do not use any patch that is damaged or shows signs of tampering.
After removing a patch, fold it in half with the sticky sides on the inside and press them
together. Return the used patch to its sachet and dispose of it in such a way that children cannot
handle it. Do not touch your eyes with your fingers and wash your hands with soap and water
after removing the patch. If your community burns domestic rubbish, you can dispose of the
patch with your domestic rubbish. Otherwise, return used patches to a pharmacy, preferably in
the original packaging.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to
throw away medicines you no longer use. These measures will help protect the environment.

6.

Contents of the pack and other information

What Emerpand contains
The active substance is rivastigmine.
Emerpand 4.6mg/24h transdermal patches: Each patch releases 4.6mg of rivastigmine per
24 hours, is 5 cm2 and contains 9.0mg of rivastigmine.
Emerpand 9.5mg/24h transdermal patches: Each patch releases 9.5mg of rivastigmine per
24 hours, is 10.0 cm2 and contains 18.0mg of rivastigmine.
Emerpand 13.3mg/24h transdermal patches: Each patch releases 13.3mg of rivastigmine
per 24 hours, is 15.0 cm2 and contains 27.0mg of rivastigmine.

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The other ingredients are butyl acrylate, methyl methacrylate, styrene alpha methylstyrene, adipic
acid ditridecyl ester, butylated hydroxytoluene (E321), 2-ethylhexyl acrylate and t-Octyl
acrylamide.

What Emerpand looks like and contents of the pack
The patch is comprised of three layers: a backing film, an adhesive layer, and a square protective
release liner. The backing layer is a translucent low-density polyethylene (LDPE) material printed
with the text "RIV4.6”, “RIV9.5” and “RIV13.3” in a repeating pattern. The polyester (PET) release
liner, which is removed prior to patch application, is translucent and coated with silicone.
One transdermal patch is sealed in one sachet. The patches are available in packs containing 7, 30, 60
and 90 sachets. Not all pack sizes may be marketed in your country.
Marketing Authorisation Holder
Actavis Group PTC ehf.
Reykjavíkurvegi 76-78
220 Hafnarfjörður
Iceland
Manufacturer
Nicobrand Limited
189 Castle Roe Road, Coleraine, BT51 3RP, UK
Specifar SA
1, 28 Octovriou str. Agia Varvara,12351, Greece
Lavipharm SA.
Agias Marinas str., Paiania Attiki, T 59, 19002, Greece
Actavis Group PTC ehf.
Reykjavíkurvegur 76-78, Hafnarfjörður, 220, Iceland
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This leaflet was last revised in December 2014.
If you would like a leaflet with a larger text, please contact
UK: 01271 385257
IE:
1890 333231

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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