rivastigmine

riv-a-STIG-meen

Commonly used brand name(s)

In the U.S.

• Exelon

Available Dosage Forms:

• Solution


• Capsule

Therapeutic Class: Central Nervous System Agent

Pharmacologic Class: Cholinesterase Inhibitor, Centrally Acting

Uses For rivastigmine

Rivastigmineis used to treat the symptoms of mild to moderate Alzheimer's disease. Rivastigmine will not cure Alzheimer's disease, and it will not stop the disease from getting worse. However, rivastigmine can improve thinking ability in some patients with Alzheimer's disease.

In Alzheimer's disease, many chemical changes take place in the brain. One of the earliest and biggest changes is that there is less of a chemical called acetylcholine (ACh). ACh helps the brain to work properly. Rivastigmine slows the breakdown of ACh, so it can build up and have a greater effect. However, as Alzheimer's disease gets worse, there will be less and less ACh, so rivastigmine may not work as well.

rivastigmine is available only with your doctor's prescription.

Before Using rivastigmine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For rivastigmine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to rivastigmine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Studies on rivastigmine have been done only in adult patients, and there is no specific information comparing use of rivastigmine in children with use in other age groups.

Geriatric

Studies on rivastigmine have been done only in middle-aged and older patients. Information on the effects of rivastigmine is based on these patients.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	B	Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking rivastigmine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using rivastigmine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Metoclopramide

Using rivastigmine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Oxybutynin


• Tolterodine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of rivastigmine. Make sure you tell your doctor if you have any other medical problems, especially:

• Asthma (or history of) or


• Blockage in the intestines or stomach, or


• Heart problems, including slow heartbeat or hypotension (low blood pressure), or


• Stomach ulcer (or history of) or


• Urinary tract blockage or difficult urination—Rivastigmine may make these conditions worse


• Epilepsy or history of seizures or


• Diabetes, hormone, or thyroid problems that are poorly controlled—Rivastigmine may cause seizures

Proper Use of rivastigmine

Take rivastigmine only as directed by your doctor.Do not take more or less of it, and do not take it more or less often than your doctor ordered. Taking too much may increase the chance of side effects, while taking too little may not improve your condition.

Rivastigmine is best taken with food.

Rivastigmine seems to work best when it is taken at regularly spaced times, usually two times a day, in the morning and evening.

Dosing

The dose of rivastigmine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of rivastigmine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (capsules):
  
  • For treatment of Alzheimer's disease:
    
    • Adults—To start, 1.5 milligrams (mg) twice a day. Your doctor may increase your dose gradually if you are doing well on rivastigmine. However, the dose is usually not more than 6 mg twice a day.
    
    
  
  

Missed Dose

If you miss a dose of rivastigmine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using rivastigmine

It is very important that your doctor check your progress at regular visits.

Tell your doctor if your symptoms get worse, or if you notice any new symptoms.

Before you have any kind of surgery, dental treatment, or emergency treatment, tell the doctor medical doctor or dentist in charge that you are taking rivastigmine. Taking rivastigmine together with medicines that are sometimes used during surgery or dental or emergency treatments may increase the effects of these medicines.

Rivastigmine may cause some people to become dizzy, clumsy, or unsteady. Make sure you know how you react to rivastigmine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert.

Rivastigmine causes a large number of patients to have problems with their stomachs and intestines. Tell your doctor about any nausea, vomiting, stomach pain or loss of appetite.

Do not stop taking rivastigmine or decrease your dose without first checking with your doctor. Stopping rivastigmine suddenly or decreasing the dose by a large amount may cause mental or behavior changes.

If you think you or someone else may have taken an overdose of rivastigmine, get emergency help at once. Taking an overdose of rivastigmine may lead to convulsions (seizures) or shock. Some signs of shock are large pupils, irregular breathing, and fast weak pulse. Other signs of an overdose are severe nausea and vomiting, increasing muscle weakness, greatly increased sweating, and greatly increased watering of the mouth.

rivastigmine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

• Diarrhea


• indigestion


• loss of appetite


• loss of strength


• nausea and vomiting


• weight loss

Less common

• High blood pressure


• fainting

Rare

• Aggression


• convulsions (seizures)


• trembling and shaking of hands and fingers


• trouble in urinating

Symptoms of overdose

• Seizures


• fast weak pulse


• greatly increased sweating


• greatly increased watering of mouth


• irregular breathing


• increasing muscle weakness


• large pupils


• low blood pressure


• nausea


• slow heartbeat


• vomiting (severe)

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Abdominal or stomach pain or cramping


• bloated full feeling


• confusion


• constipation


• mental depression


• dizziness


• fatigue


• headache


• seeing, hearing, or feeling things that are not there


• trouble in sleeping

Less common

• General feeling of discomfort or illness


• increased sweating


• runny nose

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: rivastigmine side effects (in more detail)

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More rivastigmine resources

• Rivastigmine Side Effects (in more detail)
• Rivastigmine Use in Pregnancy & Breastfeeding
• Rivastigmine Drug Interactions
• Rivastigmine Support Group
• 6 Reviews for Rivastigmine - Add your own review/rating

• Rivastigmine Prescribing Information (FDA)


• Rivastigmine Professional Patient Advice (Wolters Kluwer)


• Rivastigmine Monograph (AHFS DI)


• Rivastigmine MedFacts Consumer Leaflet (Wolters Kluwer)


• Exelon Prescribing Information (FDA)


• Exelon Consumer Overview

Compare rivastigmine with other medications

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