Dr. Saltiel received his Pharm.D. from the University of California, San Francisco, in 1980, following undergraduate work at UCLA. At UCSF, he was the recipient of the Outstanding Service Award and the Bowl of Hygeia Award. He completed a residency in clinical pharmacy practice at the University of Illinois, in Chicago.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Rivastigmine is an oral medication used to treat patients with Alzheimer's disease. Rivastigmine is in a class of drugs called cholinesterase inhibitors that also includes tacrine (Cognex), donezepil (Aricept), and galantamine (Razadyne - formerly known as Reminyl). Cholinesterase inhibitors inhibit (block) the action of acetylcholinesterase, the enzyme responsible for the destruction of acetylcholine. Acetylcholine is one of several neurotransmitters in the brain, chemicals that nerve cells use to communicate with one another. Reduced levels of acetylcholine in the brain are believed to be responsible for some of the symptoms of Alzheimer's disease. By blocking the enzyme that destroys acetylcholine, rivastigmine increases the concentration of acetylcholine in the brain, and this increase is believed to be responsible for the improvement in thinking seen with rivastigmine. For most patients who take rivastigmine there will not be a dramatic improvement, but the progression of symptoms may be slowed. After six months of treatment with rivastigmine, 25-30% of patients scored better on tests of memory, understanding, and activities of daily living as compared with only 10-20% of patients receiving placebo (a dummy or sugar pill). Rivastigmine was approved by the FDA in 1998.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Capsules: 1.5 mg (yellow), 3 mg (orange), 4.5 mg (red) and 6 mg (orange and red).
STORAGE: Capsules should be stored at room temperature, below 25°C (77°F).
PRESCRIBED FOR: Rivastigmine is used for the treatment of mild to moderate dementia of the Alzheimer's type.
DOSING: Rivastigmine usually is taken twice daily with meals. Due to gastrointestinal side effects that can be seen early in therapy, rivastigmine therapy is generally started at a low dose, often 1.5 mg twice daily, and gradually increased not more than once every 2 weeks. The goal usually is 6 mg twice daily. If a patient develops severe gastrointestinal side effects such as upset stomach and vomiting, he or she may need to stop taking rivastigmine for a few doses and then start taking it again at the same dose or a lower dose.
DRUG INTERACTIONS: Drugs with anticholinergic effects and which cross into the brain, such as atropine, benztropine (Cogentin), and trihexyphenidyl (Artane) oppose the effects of rivastigmine and should be avoided during therapy with rivastigmine.
Unlike donepezil (Aricept), rivastigmine does not cause the blood levels of other medications to rise and increase their risk for side effects.
PREGNANCY: Studies in pregnant rats and rabbits with high doses of rivastigmine failed to show effects on the offspring; however, no studies have been performed in pregnant women. Therefore, physicians must weigh the potential benefit of prescribing rivastigmine to pregnant women against the potential risks to the fetus.
NURSING MOTHERS: It is not known if rivastigmine is secreted in breast milk.
SIDE EFFECTS: About one-half of patients who take rivastigmine become nauseated, and about one-third vomit at least once, most commonly during the first few weeks of treatment as the dose is slowly increased. Between one in five and one in four patients lose weight during rivastigmine therapy (about 7 to 10 pounds, on average). One in six patients experiences a loss of appetite. About one in fifty patients develops dizziness. Overall, 15% of patients (between one in seven and one in six) discontinue therapy due to side effects.
Parkinson's disease is a slowly progressive neurologic disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Mental health is more than just being free of a mental illness. It is more
of an optimal level of thinking, feeling, and relating to others.
Mentally healthy individuals tend to have better medical health,
productivity, and social relationships.
Mental illness refers to all of the diagnosable mental disorders and is
characterized by abnormalities in thinking, feelings, or behaviors.
Some of the most common types of mental illness include anxiety,
depressive, behavioral, and substance-abuse disorders.
There is no single cause for mental illness. Rather, it is the result of a
complex group of genetic, psychological, and environmental factors.
While everyone experiences sadness, anxiety, irritability, and moodiness at
times, moods, thoughts, behaviors, or use of substances that interfere with a
person's ability to function well physically, socially, at work, school, o...
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