Uses
What is rivastigmine used for?
Rivastigmine is commonly used to treat dementia related to Alzheimer’s disease and Parkinson’s disease.
Rivastigmine may also be used for other conditions as determined by your healthcare provider.
How does rivastigmine work (mechanism of action)?
People with Alzheimer’s disease typically have a decrease in the amount of acetylcholine in their brain. Acetylcholine is a natural chemical in the brain that helps carry messages between brain cells. When there is less acetylcholine, it leads to problems in memory and thinking. Rivastigmine may help manage symptoms of Alzheimer’s disease by preventing the breakdown of acetylcholine, allowing more acetylcholine to build up in the brain.
How is rivastigmine supplied (dosage forms)?
Rivastigmine is available as Exelon and generic rivastigmine in the following dosage forms that are applied to the skin or taken by mouth.
- 1.5 mg, 3 mg, 4.5 mg, 6 mg oral capsules
- 4.6 mg/24 hr, 9.5 mg/24 hr, 13.3 mg/24 hr transdermal patches
How should I store rivastigmine?
Rivastigmine should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.
Rivastigmine transdermal patches. Keep the patch in the individually sealed pouch until you are ready to apply it. Used patches should be folded with the adhesive surfaces pressed together and discarded in the trash
Side Effects
What are the most common side effects of rivastigmine?
The most common side effects of rivastigmine are listed below. Tell your healthcare provider if you have any of these side effects that bother you.
- Nausea/vomiting, diarrhea (see below)
- Decreased appetite
- Upset stomach (or indigestion)
- Feeling unusually weak or tired
There may be other side effects of rivastigmine that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
What are the serious side effects of rivastigmine?
While less common, the most serious side effects of rivastigmine are described below, along with what to do if they happen.
Severe Allergic Reactions. Rivastigmine may cause allergic reactions, which can be serious. Stop using rivastigmine and get help right away if you have any of the following symptoms of a serious allergic reaction.
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, or throat
- Trouble swallowing or throat tightness
- Itching, skin rash, or pale red bumps on the skin called hives
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
Gastrointestinal Problems. Rivastigmine can cause nausea, vomiting, and diarrhea that may require you to stop treatment in some cases. Serious problems, such as dehydration may occur. There is an increased risk of side effects when taking higher doses. Tell your healthcare provider if you have nausea, vomiting, or diarrhea that doesn’t go away.
Skin Reactions. Rivastigmine patches may cause a skin reaction called allergic contact dermatitis where the patch was applied. Stop using rivastigmine transdermal patches and call your healthcare provider if you have any of the following symptoms and they do not get better within 2 days (48 hours) after removing the patch.
- Skin redness or swelling
- Peeling or blisters on your skin
- Symptoms spreading to the area of skin beyond your patch application site
Movement Problems. Rivastigmine may rarely cause involuntary movement problems, including shakiness, stiffness, or jerkiness. Call your healthcare provider right away if you develop any unusual or uncontrolled movements.
Seizures. Some people who have taken rivastigmine have reported having seizures. There are many different types of seizures and some of them are not easy to recognize. Stop taking rivastigmine and call your healthcare provider if you experience any of the following signs that a seizure is happening or could happen.
- Muscle twitching, jerking, spasms, tremors, or other uncontrolled movements
- Stiffening of your arms and legs
- Feeling anxious, nervous, confused, or a sense of dread
- Feeling dizzy or lightheaded
- Falling or losing consciousness
Stomach Bleeding. Rivastigmine may increase your risk of bleeding, ulcers, and tears (perforation) in your gut. The risk is higher if you have a history of stomach ulcers, bleeding problems, or take certain other medicines. Stop taking rivastigmine and get emergency help right away if you have any of the following symptoms.
- Vomit blood
- Black or tarry poop
- Stomach pain that does not go away
- Upset stomach
- Feel faint
Heart Rhythm Changes. Rivastigmine may cause heart rhythm problems that can lead to an irregular heartbeat and fainting. In rare cases, this may cause the heart to suddenly stop beating (cardiac arrest). Some people have a higher risk of this, including people with existing heart disease or who take other medicines that affect the heart. Get emergency help if you experience any of the following signs of heart rhythm changes.
- Chest pain
- Shortness of breath
- Feeling dizzy, lightheaded, or fainting
- Changes in your heart rate or rhythm, such as a fast, slow, pounding or skipping heartbeat
Inability to Empty Bladder (Urinary Retention). Rivastigmine might make it harder to empty your bladder. Call your healthcare provider right away if you cannot empty your bladder.
Warnings & Precautions
Who should not use rivastigmine?
Allergies to Ingredients. People who are allergic to any of the following should not use rivastigmine.
- Rivastigmine
- Exelon
- Any other medicine known as carbamates
- Any of the ingredients in the specific product dispensed
Your pharmacist can tell you all of the ingredients in the specific rivastigmine products they stock.
Allergic Contact Dermatitis. People who had a skin reaction called allergic contact dermatitis to rivastigmine transdermal patches in the past should not use them again. People who have had a skin reaction to rivastigmine transdermal patches in the past might also have an allergic reaction to rivastigmine oral capsules. If you had a skin reaction in the past to rivastigmine patches, check with your healthcare provider before taking rivastigmine capsules.
What should I know about rivastigmine before using it?
Do not use rivastigmine unless it has been prescribed to you by a healthcare provider. Use it as prescribed.
Do not share rivastigmine with other people, even if they have the same condition as you. It may harm them.
Keep rivastigmine out of the reach of children.
Rivastigmine can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how rivastigmine affects you.
Rivastigmine oral capsules should be taken twice a day in the morning and evening with meals.
Apply the transdermal patch once daily. Do not use rivastigmine transdermal patches if the pouch seal is broken, or if the patch is cut, damaged, or altered. Choose a place on your skin to apply the patch that is clean, dry, hairless, and intact. Do not apply the patch to skin that is red, irritated, or cut. Do not apply the patch to an area of your skin where cream, lotion, or powder has recently been applied. Make sure the place you choose on your skin will not be rubbed against by tight clothing.
Replace the rivastigmine patch with a new patch every 24 hours. Only wear one patch at a time. Remove the previous day’s patch before applying a new one. If a patch falls off, replace it with a new patch. Change this patch at your normal application time the following day. You can change the site of application of your patch each day to minimize potential skin irritation. You can use the same general body area on consecutive days. Do not apply a new patch on the same location for at least 14 days.
If you are prescribed rivastigmine transdermal patches, avoid exposure to heat sources for long periods of time. Examples of heat sources include excessive sunlight, saunas, sunrooms, or heating pads. Heat exposure could make too much medicine be absorbed into your body. However, you may wear your patch during bathing and in hot weather.
What should I tell my healthcare provider before using rivastigmine?
Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if rivastigmine is right for you.
In particular, make sure that you discuss any of the following.
Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.
- Heart problems, including irregular, slow, or fast heartbeat
- Lung problems, including asthma or obstructive pulmonary disease
- Seizures
- Stomach ulcers
- Difficulty passing urine
- Liver problems
- Kidney problems
- Trouble swallowing tablets
- Planned surgery, medical procedures, or dental surgery or procedures
Other Medicines and Supplements. Rivastigmine may interact with other medicines and supplements. Before taking rivastigmine, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.
Pregnancy. It is not known if or how rivastigmine could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant.
Breastfeeding. It is not known if rivastigmine passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should use rivastigmine while breastfeeding.
Interactions
Does rivastigmine interact with foods or drinks?
There are no known interactions between rivastigmine and foods or drinks.
It is unknown if drinking alcohol will affect rivastigmine. The risk of drowsiness, dizziness, weakness, or fainting may be increased if you drink alcohol while taking rivastigmine.
Does rivastigmine interact with other medicines (drug interactions)?
Rivastigmine interacts with many other medicines. Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
In particular, make sure that you discuss if you are using any of the following before using rivastigmine.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and others, which are contained in many prescription and OTC products for pain, swelling, and fever
- A medicine used to treat Alzheimer’s or Parkinson’s disease
- Anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
- Metoclopramide, which is a medicine for nausea, gastroesophageal reflux disease (GERD), or nausea and vomiting after surgery or chemotherapy treatment
- A beta-blocker, such as metoprolol (Lopressor), atenolol (Tenormin), or propranolol (Inderal LA), which is a medicine that may be used for certain heart conditions or to reduce blood pressure
- Anesthesia given to you by your healthcare provider during surgery, medical procedures, or dental procedures
This may not be a complete list of medicines that can interact with rivastigmine. Always check with your healthcare provider.
Overdose/Missed Dose
What should I do if I accidentally use too much rivastigmine?
If you or someone else has used too much rivastigmine, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.
What should I do if I miss a dose of rivastigmine?
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.
If you miss more than 3 days of rivastigmine, talk to your healthcare provider for instructions before starting again.
Transdermal Patch. If the patch falls off before your usual replacement time, apply a new patch right away, and remove it at your usual replacement time the next day. Do not try to reapply a patch that has become loose or fallen off. Do not apply double or extra patches. If you miss more than 3 doses of rivastigmine, talk to your healthcare provider for instructions before starting again. Your healthcare provider may change your dose.
Are you currently using Rivastigmine (Exelon)?
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