Rivastigmine is a reversible cholinesterase inhibitor. It was previously available in the US as brand name Exelon® but now is available only as generic capsules. It is also available as a patch—Exelon® Patch or generic. On this page, we present some basic information about this medication. Other articles on this website with more advanced information and tips related to this medication are linked to under Related Pages below
Rivastigmine (previously brand name Exelon®)
FDA-approved indications
Treatment of mild to moderate dementia of the Alzheimer’s type Treatment of mild to moderate dementia associated with Parkinson’s disease
Dosage and Administration
Alzheimer’s Disease Initial: 1.5 mg orally twice a day Titration: After a minimum of 2 weeks, if tolerated, increase the dose to 3 mg twice a day and further to 4.5 mg twice a day and 6 mg twice a day with a minimum of 2 weeks between each dose increase. Maximum: 6 mg twice a day
Parkinson’s Disease Dementia Initial: 1.5 mg orally twice a day Titration: After a minimum of 4 weeks, if tolerated, increase the dose to 3 mg twice a day and further to 4.5.mg twice a day and 6 mg twice a day with a minimum of 4 weeks between each dose increase. Maximum: 6 mg twice a day
Instructions Rivastigmine should be taken with meals in divided doses in the morning and evening. Rivastigmine oral solution and capsules may be interchanged at equal doses. If adverse effects (e.g., nausea, vomiting, abdominal pain, loss of appetite) cause intolerance during treatment, the patient should be instructed to discontinue treatment for several doses and then restart at the same or next lower dose level.
Interruption of treatment If adverse effects (e.g., nausea, vomiting, abdominal pain, loss of appetite) cause intolerance during treatment, the patient should be instructed to discontinue treatment for several doses and then restart at the same or next lower dose level. If dosing is interrupted for 3 days or fewer, restart treatment with the same or lower dose of rivastigmine. If dosing is interrupted for more than 3 days, treatment should be restarted with 1.5 mg twice a day and then titrated upwards as described above.
Dosage forms and strengths
Capsules: 1.5 mg, 3 mg, 4.5 mg, or 6 mg Oral solution: 2 mg/mL
Rivastigmine Transdermal System (Exelon® Patch)
FDA-approved indications
Treatment of mild, moderate, and severe dementia of the Alzheimer’s type Treatment of mild to moderate dementia associated with Parkinson’s disease
Dosage and Administration
Mild to moderate Alzheimer’s disease and Parkinson’s disease dementia 9.5 mg/24 hours or 13.3 mg/24 hours once daily
Severe Alzheimer’s disease 13.3 mg/24 hours once daily
Dosing instructions Initial: 4.6 mg/24 hours. Apply patch on intact skin for a 24-hour period; replace with a new patch every 24 hours. Titrate: After a minimum of 4 weeks of initial treatment, if tolerated, the dose may be titrated upwards to 9.5 mg/24 hours which is the minimum effective dose. Maximum: After waiting for additional 4 weeks, increase dosage to maximum dosage of 13.3 mg/24 hours. Interruption of treatment For treatment interruption longer than 3 days, retitrate dosage starting at 4.6 mg/24 hours. Special Populations Mild to moderate hepatic impairment: Use 4.6 mg/24 hours as both initial and maintenance dose Low (<50 kg) body weight: Watch for the development of toxicities (e.g. excessive nausea, vomiting, etc.). Consider reducing the maintenance dose to 4.6 mg/24 hours if toxicities develop.
Switching to rivastigmine patch from rivastigmine capsules or oral solution Patient on a total daily dose of <6 mg of oral rivastigmine: Can be switched to the 4.6 mg/24 hours patch Patient on a total daily dose of 6 mg to 12 mg of oral rivastigmine: Can be switched to the 9.5 mg/24 hours patch Instruct patients or caregivers to apply the first patch on the day following the last oral dose.
Dosage forms and strengths
Transdermal patch: 4.6 mg/24 hr, 9.5 mg/24 hr, 13.3 mg/24 hr
Important! Please refer to the full Prescribing Information (see link below) before prescribing this medication.
Related Pages
Alzheimer’s disease: Medications
How to choose a cholinesterase inhibitor
Switch cholinesterase inhibitors?
Medications for dementia: Alternative preparations
Donepezil (Aricept®, Aricept ODT®): Basic Information
Galantamine (Razadyne, Razadyne ER): Basic Information
Tips for interviewing patients with dementia
Neuroimaging in persons with dementia
Key points from the APA Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia
Neurocognitive disorders: Classification
References
Rivastigmine (Exelon®) prescribing information
Rivastigmine Transdermal System (Exelon® Patch) prescribing information
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