Exelon (rivastigmine, Exelon Patch)

  • Pharmacy Author:
    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.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    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.

Quick Guide to Dementia

What brand names are available for rivastigmine?

Exelon, Exelon Patch

Is rivastigmine available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for rivastigmine?

Yes

What are the uses for rivastigmine?

What are the side effects of rivastigmine?

  • The most common side effects Exelon and Exelon Patch are:
    • Dizziness
    • Diarrhea
    • Headache
    • Stomach pain
    • Vomiting
    • Nausea
    • Weight loss
    • About one-half of patients who take Exelon and Exelon Patch develop symptoms of nausea, 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.
  • Serious side effects include:

Quick GuideDementia, Alzheimer's Disease, and Aging Brains

Dementia, Alzheimer's Disease, and Aging Brains

What is the dosage for rivastigmine?

  • Exelon and Exelon Patch 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.

Exelon and Exelon Patch for treating dementia associated with Alzheimer's disease

  • 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.

Exelon and Exelon Patch for treating dementia associated with Parkinson's disease

  • 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.

Which drugs or supplements interact with rivastigmine?

  • 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 Exelon and Exelon Patch.
  • Unlike donepezil (Aricept), Exelon and Exelon Patch does not cause the blood levels of other medications to rise and increase their risk for side effects.

Is rivastigmine safe to take if I'm pregnant or breastfeeding?

  • Studies in pregnant rats and rabbits with high doses of Exelon and Exelon Patch 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 Exelon and Exelon Patch to pregnant women against the potential risks to the fetus.
  • It is not known if rivastigmine is secreted in breast milk.

What else should I know about rivastigmine?

What preparations of rivastigmine are available?

  • Capsules: 1.5 mg; 3 mg; 4.5 mg; 6 mg
  • Patch: 4.6 mg/24 hours; 9.5 mg/24 hours; 13.3 mg/24 hours

How should I keep rivastigmine stored?

Capsules and solution should be stored at room temperature between 15 C and 30 C (59 F and 86 F).

Reference: FDA Prescribing Information

Quick GuideDementia, Alzheimer's Disease, and Aging Brains

Dementia, Alzheimer's Disease, and Aging Brains

Summary

Exelon and Exelon Patch (Rivastigmine) is a drug prescribed for the treatment of mild to moderate dementia of the Alzheimer's type and mild to moderate dementia associated with Parkinson's disease. Side effects include

Dosage, drug interactions, warnings and precautions, and pregnancy and breastfeeding safety should be reviewed prior to taking this medication.

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See more info: rivastigmine on RxList
Reviewed on 9/22/2016
References
Reference: FDA Prescribing Information

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