rivastigmine, Exelon (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
GENERIC AVAILABLE: Yes
PREPARATIONS: Capsules: 1.5, 3, 4.5, and 6 mg. Solution: 2 mg/ml. Patch: 4.6mg/24 hours, 9.5 mg/24 hours
STORAGE: Capsules and solution should be stored at room temperature, 15-30 C (59-86 F).
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.
For treating dementia associated with Alzheimer's the starting dose is 1.5 mg twice daily. It is gradually increased no more than once every two weeks. The goal usually is 3 to 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.
The starting dose for treating dementia associated with Parkinson's disease is 1.5 mg orally twice daily. The dose may be increased every four weeks to 3 to 6 mg twice daily. When using the patch the recommended starting dose is 4.6 mg/24 hours patch once daily. The patch should be replaced with a new one every day. The maximum dose is one 9.5 mg/24 hour patch. At least four weeks should elapse before increasing the dose.
DRUG INTERACTIONS: Drugs with anticholinergic effects and which cross into the brain, such as atropine, benztropine (Cogentin), and trihexylphenidyl (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.
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