Symptomatic treatment of mild to moderately severe Alzheimer's dementia, & mild to moderately severe dementia in patients w/ idiopathic Parkinson's disease.
Initially 1.5 mg bd, may be increased to 3 mg bd if well tolerated after a min of 2 wk. Subsequent increases to 4.5 mg & then 6 mg bd may be considered after a min of 2 wk based on good tolerability of current dose. Effective dose: 3-6 mg bd. Maintain on highest well tolerated dose. Max daily dose: 6 mg bd.
View Exelon overdosage for action to be taken in the event of an overdose.
Administration
Should be taken with food: Swallow whole. Do not open/crush.
Contraindications
Hypersensitivity to rivastigmine or other carbamate derivatives. Previous history of application site reactions suggestive of allergic contact dermatitis w/ rivastigmine patch.
Incidence & severity of adverse reactions increase w/ higher doses. Re-initiate at 1.5 mg bd to reduce possibility of adverse reactions if treatment is interrupted for >3 days. Patients who develop application site reactions suggestive of allergic contact dermatitis to rivastigmine patch & who still require rivastigmine treatment should only be switched to oral rivastigmine after -ve allergy testing & under close medical supervision. Rare post-marketing reports of allergic dermatitis (disseminated) irrespective of the route of administration. Dose-related GI disorders may occur particularly when initiating treatment &/or increasing dose, & occur more commonly in women. Associated w/ wt loss in patients w/ Alzheimer's disease. May exacerbate or induce extrapyramidal symptoms. Minor or moderate influence on the ability to drive & use machines. Caution in patients w/ pre-existing, or family history of, QTc prolongation or at higher risk of developing torsade de pointes; sick sinus syndrome or conduction defects (SA block, AV block); active gastric or duodenal ulcers or those w/ predisposition to these conditions; history of asthma or obstructive pulmonary disease; predisposition to urinary obstruction & seizures. Not recommended in patients w/ severe dementia of Alzheimer's disease or associated w/ Parkinson's disease, other types of dementia, or other types of memory impairment (eg, age-related cognitive decline). Patients w/ clinically significant renal or hepatic impairment & patients weighing <50 kg may experience more adverse reactions. Should not be used during pregnancy unless clearly necessary. Do not breast-feed. No relevant use in paed population.
May exaggerate effects of succinylcholine-type muscle relaxants during anaesth. Possible additive effects w/ other cholinomimetic substances. Might interfere w/ activity of anticholinergic medicinal products (eg, oxybutynin, tolterodine). Reports of additive effects leading to bradycardia (which may result in syncope) when combined w/ various β-blockers (including atenolol). Caution when combined w/ β-blockers & other bradycardia agents (eg, class III antiarrhythmics, Ca channel antagonists, digitalis glycoside, pilocarpine); QT prolongation- or torsades de pointes-inducing medicinal products eg, antipsychotics [ie, some phenothiazines (chlorpromazine, levomepromazine)], benzamides (sulpiride, sultopride, amisulpride, tiapride, veralipride), pimozide, haloperidol, droperidol, cisapride, citalopram, diphemanil, IV erythromycin, halofantrine, mizolastine, methadone, pentamidine, moxifloxacin. May inhibit butyrylcholinesterase-mediated metabolism of other substances.
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