Rivastigmine

Rivastigmine treats dementia in people with Alzheimer's or Parkinsons disease.

Rivastigmine Overview

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Rivastigmine is a prescription medication used to treat dementia in people with Alzheimer's disease or Parkinson's disease. Rivastigmine belongs to a group of drugs called acetylcholinesterase inhibitors. It works by increasing the amount of certain natural subtances to improve mental function. 

This medication comes in capsule, and oral solution (liquid) forms. It is usually taken twice a day with meals. Rivastigmine is also available as a patch to be applied to the skin once daily.
 
Common side effects include nausea, vomiting, loss of appetite, and dizziness.
 

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Rivastigmine Cautionary Labels

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Uses of Rivastigmine

Rivastigmine is a prescription medicine used to treat dementia in people with Alzheimer's disease or Parkinson's disease.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. 
 

Rivastigmine Brand Names

Rivastigmine may be found in some form under the following brand names:

Rivastigmine Drug Class

Rivastigmine is part of the drug class:

Side Effects of Rivastigmine

Rivastigmine may cause serious side effects. See "Drug Precautions" section.

The most common side effects of rivastigmine include: 
  • nausea
  • vomiting
  • loss of appetite
  • dizziness

The most common side effects of rivastigmine patch include:

  • depression
  • headache
  • anxiety
  • dizziness
  • stomach pain
  • urinary tract infections
  • muscle weakness
  • tiredness
  • trouble sleeping

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.  These are not all the possible side effects of rivastigmine.  For more information, ask your healthcare provider or pharmacist.

Rivastigmine Interactions

Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following:

  • antihistamines
  • aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
  • bethanechol (Duvoid, Urabeth, Urecholine)
  • ipratropium (Atrovent)
  • medicines for Alzheimer's disease
  • glaucoma medicines
  • medicines for irritable bowel disease, motion sickness, myasthenia gravis, Parkinson's disease, ulcers, or urinary problems. 

Your doctor may need to change the doses of your medications or monitor you carefully for side effects. 

Rivastigmine Precautions

Rivastigmine may cause serious side effects including:    

  • stomach or bowel (intestinal) problems, including:
    • nausea  
    • vomiting 
    • diarrhea 
    • loss of appetite 
    • weight loss 
    • bleeding in your stomach (ulcers) 
  • heart problems 
  • seizures 
  • problems with movement (tremors) 
  • Skin reactions. Some people have had a serious skin reaction called allergic contact dermatitis (ACD) when using rivastigmine patch. Stop using rivastigmine patch and call your healthcare provider right away if you experience reactions that spread beyond the patch size, are intense in nature and do not improve within 48 hours after the patch is removed. Symptoms of ACD may be intense and include:
    • itching, redness, swelling, warmth or tenderness of the skin
    • peeling or blistering of the skin that may ooze, drain or crust over

Do not take rivastigmine if you are allergic to any of the ingredients rivastigmine. 

Rivastigmine Food Interactions

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of rivastigmine there are no specific foods that you must exclude from your diet when receiving this medication.

Inform MD

Before taking rivastigmine:

  • tell your doctor and pharmacist if you are allergic to rivastigmine, neostigmine (Prostigmin), physostigmine (Antilirium, Isopto Eserine), pyridostigmine (Mestinon, Regonol), any other medications, or any of the ingredients in rivastigmine solution. Ask your pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antihistamines; aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); bethanechol (Duvoid, Urabeth, Urecholine); ipratropium (Atrovent); and medications for Alzheimer's disease, glaucoma, irritable bowel disease, motion sickness, myasthenia gravis, Parkinson's disease, ulcers, or urinary problems. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. 
  • tell your doctor if you have or have ever had asthma, an enlarged prostate or other condition that blocks the flow of urine, ulcers, abnormal heart beats, or other heartor lung disease. 
  • tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking rivastigmine, call your doctor. 
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking rivastigmine.

Rivastigmine and Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Rivastigmine falls into category B. There are no well-done studies that have been done in humans with rivastigmine. But in animal studies, pregnant animals were given this medication, and the babies did not show any medical issues related to this medication.

 

Rivastigmine and Lactation

It is not known if rivastigmine crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using rivastigmine.

 

Rivastigmine Usage

  • Rivastigmine comes as a capsule and solution (liquid) to take by mouth. It is usually taken twice a day with meals in the morning and evening. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take rivastigmine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor will start you on a low dose of rivastigmine and slowly increase your dose, but not more than once every 2 weeks.
  • Rivastigmine may improve the ability to think and remember or slow the loss of these abilities, but does not cure Alzheimer's disease or dementia in people with Parkinson's disease. Continue to take rivastigmine even if you feel well. Do not stop taking rivastigmine without talking to your doctor.
  • If you are taking rivastigmine oral solution, ask your pharmacist or doctor for a copy of the manufacturer's instructions for use. Carefully read these instructions. Always use the oral dosing syringe that comes with rivastigmine solution to measure your dose. Talk to your doctor or pharmacist if you have questions about how to measure your dose of rivastigmine solution.
  • Rivastigmine oral solution may be swallowed directly from the syringe or mixed with a liquid before use. Mix it with a small glass of water, cold fruit juice, or soda. Be sure to stir the mixture completely. Do not mix this medication with any liquid other than the ones listed. If the medication is mixed with water, juice, or soda, it must be taken within 4 hours.

Follow these steps to take a dose of rivastigmine:

  • Remove the oral dosing syringe that came with this medication from its protective case. 
  • Push down and twist off the child-resistant cap to open the bottle of rivastigmine solution. 
  • Put the tip of the oral syringe into the white stopper opening on top of the bottle. 
  • While holding the syringe straight up, pull up on the plunger to the mark on the syringe that equals your dose. 
  • Check the liquid in the syringe for air bubbles. If there are large air bubbles, gently move the syringe plunger up and down a few times. Do not worry about a few tiny air bubbles. 
  • Make sure the plunger is on the mark on the syringe that equals your dose. 
  • Remove the oral syringe from the bottle by pulling up on it. 
  • Swallow your dose from the syringe directly, or mix it with the liquid you have chosen. Drink or swallow all of the solution. 
  • Wipe off the outside of the oral syringe with a clean tissue, and put the syringe back into its case. 
  • Close the child-resistant cap on the bottle of medication.

Rivastigmine patch

  • Use rivastigmine patch exactly as your healthcare provider tells you to use it.
  • Rivastigmine patches come in 3 different dosage strengths.
  • Your healthcare provider may change your dose as needed.
  • Wear only 1 rivastigmine patch at a time.
  • Rivastigmine patch is for skin use only. 
  • Only apply rivastigmine patch to healthy skin that is clean, dry, hairless, and free of redness, irritation, burns or cuts.
  • Avoid applying rivastigmine patch to areas on your body that will be rubbed against tight clothing.
  • Do not apply rivastigmine patch to skin that has cream, lotion, or powder on it.
  • Change your rivastigmine patch every 24 hours at the same time of day. You may write the date and time you put on the rivastigmine patch with a ballpoint pen before applying the patch to help you remember when to remove it.
  • Change your application site every day to avoid skin irritation. You can use the same area, but do not use the exact same spot for at least 14 days after your last application.
  • Check to see if the rivastigmine patch has become loose when you are bathing, swimming, or showering.
  • Rivastigmine patch is designed to deliver medication during the time it is worn. If your rivastigmine patch falls off before its usual replacement time, put on a new rivastigmine patch right away. Replace the new patch the next day at the same time as usual. Do not use overlays, bandages, or tape to secure an rivastigmine patch that has become loose or try to reapply an rivastigmine patch that has fallen off. 
  • If you miss a dose or forget to change your rivastigmine patch apply your next rivastigmine patch as soon as you remember. Do not apply 2 rivastigmine patches to make up for the missed dose.
  • If you miss more than 3 doses of applying rivastigmine patch, call your healthcare provider before putting on a new rivastigmine patch. You may need to restart rivastigmine patch at a lower dose.
  • Always remove the old rivastigmine patch from the previous day before you apply a new one.
  • Having more than 1 rivastigmine patch on your body at the same time can cause you to get too much medicine. If you accidentally use more than 1 rivastigmine patch at a time, call your healthcare provider right away. If you are unable to reach your healthcare provider, call your local Poison Control Center at 1-800-222-1222 or go to the nearest hospital emergency room right away.

What should I avoid while using rivastigmine patch?

  • Do not touch your eyes after you touch the rivastigmine patch. In case of accidental contact with your eyes or if your eyes become red after handling the patch, rinse immediately with plenty of water and seek medical advice if symptoms do not resolve.
  • Rivastigmine patch can cause drowsiness, dizziness, weakness, or fainting. Do not drive, operate heavy machinery, or do other dangerous activities until you know how rivastigmine patch affects you.
  • Avoid exposure to heat sources such as excessive sunlight, saunas, or sun-rooms for long periods of time.

Rivastigmine Dosage

Follow the directions on your prescription label carefully. Your doctor will determine the best dose for you.

  • The recommended rivastigmine starting dose for Alzheimer's Dementia is 1.5 mg taken twice daily. The dose may be increased after a minimum of 2 weeks, to 3 mg twice daily, if rivastigmine is well tolerated and dose increase is necessary. After two more weeks, the dose may be further increased to 4.5 mg taken twice daily. Then, after an additional two weeks, the maximum recommended dose of 6 mg twice daily may be given.
  • The recommended rivastigmine starting dose for Parkinson's Dementia is 1.5 mg taken twice daily. The dose may be increased after a minimum of 4 weeks, to 3 mg twice daily, if rivastigmine is well tolerated and dose increase is necessary. After four more weeks, the dose may be further increased to 4.5 mg taken twice daily. Then, after an additional four weeks, the maximum recommended dose is 6 mg twice daily may be given.

Rivastigmine Patch

  • Rivastigmine patches come in 3 different dosage strengths.
  • Your healthcare provider may change your dose as needed.
  • Wear only 1 patch at a time.

Rivastigmine Overdose

If you have taken too much rivastigmine (more than the prescribed amount) call your local Poison Control Center or seek emergency medical attention right away.

  • Having more than 1 rivastigmine patch on your body at the same time can cause you to get too much medicine. If you accidentally use more than 1 patch at a time, call your healthcare provider right away. If you are unable to reach your healthcare provider, call your local Poison Control Center at 1-800-222-1222 or go to the nearest hospital emergency room right away.

Other Requirements

  • Store rivastigmine capsules at controlled room temperature in a tight container.
  • Protect rivastigmine solution from freezing and store in an upright position.
  • Store patches between 68°F to 77°F (20°C to 25°C). 
  • Keep rivastigmine patches in the sealed pouch until ready to use.

Keep this and all medicines out of the reach of children.