Medication Information
Rivastigmine Tartrate (generic) ~ Exelon (brand)

Classification: Reversible cholinesterase inhibitor.

Common Usage: Rivastigmine tartrate is indicated for the treatment of mild to moderate dementia of the Alzheimer's type, as well as the treatment of mild to moderate dementia associated with Parkinson's disease. Its use in the pediatric population has not been studied.

Warnings: Gastrointestinal adverse reactions:
Rivastigmine use can be associated with significant stomach-related side effects (nausea, vomiting, loss of appetite, and weight loss), especially if the dose is increased too rapidly. For this reason, patients should always be started at a low dose (1.5 mg twice each day). Use of this medication is associated with the development of anorexia in some patients.

Important Side Effects: This medication may increase gastric acid secretion; patients should be monitored closely for symptoms of gastrointestinal bleeding. Other side effects include increased sweating, fatigue, dizziness, headache and tremor.

This is not a complete list of all known or potential adverse effects. Notify your prescriber or pharmacist of any symptoms that have started since you began taking this medication, changing its dose, or adding or changing other medication or diet. Take care when performing any task (for example, driving or operating machinery) that requires your attention until you have experience with this drug and are confident you can perform the task safely.

Interactions with Other Medications: Anticholinergic drugs should be avoided, as they will directly antagonize the action of rivastigmine. These medications are occasionally prescribed for Parkinson's Disease, irritable bowel, or urinary incontinence. Examples of anticholinergic drugs are atropine (Urised, Motofen, and others), benztropine (Cogentin), tri-hexyphenidyl (Artane), and oxybutynin (Ditropan). Neuromuscular blocking agents given during anesthesia or cholinergic drugs such as bethanechol (Urecholine) may have increased effects in the presence of rivastigmine.

This is not a complete list of all known or potential drug interactions. To help prevent problems, always make sure that your pharmacist and all prescribers know about all medications you are taking, including over-the-counter drugs; dietary herbal supplements; folk or home remedies; or unusual foods, drinks or dietary habits.

Common Dosages: Dementia of the Alzheimer's type: The recommended starting dosage for rivastigmine is 1.5 mg twice daily. If this dose is well tolerated after a minimum of two weeks of treatment, the dose may be increased to 3 mg twice daily. Subsequent dosage increases of 4.5 mg twice daily and 6 mg twice daily should be attempted after a minimum of two weeks at the previous dose. The maximum dose is 6 mg twice daily (12 mg/day).

Dementia associated with Parkinson's disease: The dosage shown to be effective in the single controlled clinical trial for this indication is 3 to 12 mg/day, given as a twice a day dosing (daily doses of 1.5 mg to 6 mg twice daily. The starting dose should be 1.5 mg twice a day; subsequently the dose can be increased to 3 mg twice daily and further to 4.5 mg twice daily or 6 mg twice daily. The maximum dose is 6 mg twice daily (12 mg/day).

Rivastigmine should be taken with meals in divided doses in the morning and in the evening. If you miss a dose, you should take it as soon as you remember. If it is less than 6 hours until your next dose, skip the dose and continue with the next dose. Do not double doses. Do not stop or change the dose of this medication without discussing this in advance with your prescriber and pharmacist.

The use of rivastigmine has been associated with significant stomach-related side effects. If these side effects occur, patients should be instructed to discontinue treatment for several doses and then restart it at the same or next lower dose.

Identification: Rivastigmine is available in 1.5 mg yellow capsules with "Exelon 1.5 mg" printed in red on the body of the capsule. It is available in 3 mg orange capsules with "Exelon 3 mg" printed in red on the body of the capsule. Rivastigmine is available in 4.5 mg red capsules with "Exelon 4.5" printed in red on the body of the capsule. It is available in 6 mg orange and red capsules with "Exelon 6 mg" printed in red on the body of the capsule.

Rivastigmine is also available in a clear, yellow, oral solution (2 mg/mL). The oral solution is packaged with a dispenser set which consists of an assembled oral dosing syringe that allows dispensing a maximum volume of 3 mL corresponding to a 6-mg dose.

Storage: Store rivastigmine capsules at normal room temperature (59° F to 86° F) in a tightly closed, child, light and moisture-resistant container. The oral solution should be stored below 77° in the amber bottle in which it is dispensed. If you have difficulty opening child-resistant containers, your pharmacist can provide you with a container that is easier to open. Keep the medication out of direct sunlight and avoid storing it in a warm and humid area - such as the bathroom or kitchen - to prevent deterioration. To prevent accidental poisoning, keep all medications out of the reach of children. Do not take an expired medication. Do not transfer medication from one container to another. Carefully discard discontinued medication where adults with dementia or children cannot find it.