Exelon Patch

Rivastigmine

Symptomatic treatment of mild to moderately severe Alzheimer's dementia.

Initially 4.6 mg/24 hr. Increase to 9.5 mg/24 hr (recommended daily effective dose) after a min of 4 wk & if well tolerated. May consider increasing to 13.3 mg/24 hr if well tolerated & only after a min of 6 mth at 9.5 mg/24 hr. Apply once daily to clean, dry, hairless, intact healthy skin on the upper or lower back, upper arm or chest, in a place which will not be rubbed by tight clothing.

Hypersensitivity to rivastigmine or other carbamate derivatives. Previous history of application site reactions suggestive of allergic contact dermatitis w/ rivastigmine patch.

Not recommended to apply to the thigh or abdomen. Do not apply to red, irritated or cut skin. Avoid reapplication to the exact same skin location w/in 14 days. If treatment is interrupted for >3 days, it should be re-initiated w/ 4.6 mg/24 hr. GI disorders (eg, nausea, vomiting, diarrhoea) may occur when initiating treatment &/or increasing the dose. Monitor patient's wt during therapy. 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 & AV block); active gastric or duodenal ulcers or those predisposed to these conditions; predisposed to urinary obstruction & seizures; history of asthma or obstructive pulmonary disease. Discontinue treatment in case of suspected allergic contact dermatitis. 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. May exacerbate or induce extrapyramidal symptoms. Avoid contact w/ eyes & wash hands w/ soap & water after removing the patch. May induce syncope or delirium. Minor or moderate influence on ability to drive & use machines. Carefully titrate & monitor patients weighing <50 kg. Exercise caution in titrating patients w/ severe hepatic impairment. Do not use during pregnancy unless clearly necessary. Do not breast-feed. No relevant use in paed population in the treatment of Alzheimer's disease.

Application site reactions (erythema, pruritus, oedema, dermatitis, irritation), asthenic conditions (eg, fatigue, asthenia), pyrexia, decreased wt; nausea, vomiting, diarrhoea, dyspepsia, abdominal pain; UTI; anorexia, decreased appetite; anxiety, depression, delirium, agitation; headache, syncope, dizziness; rash; urinary incontinence.

May exaggerate effects of succinylcholine-type muscle relaxants during anaesth. Possible additive effects w/ other cholinomimetic substances. Might interfere w/ the activity of anticholinergic medicinal products (eg, oxybutynin, tolterodine). Additive effects leading to bradycardia w/ β-blockers (eg, atenolol) & other bradycardia agents (eg, class III antiarrhythmics, Ca channel antagonists, digitalis glycoside, pilocarpine). Caution w/ 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, erythromycin IV, halofantrine, mizolastine, methadone, pentamidine & moxifloxacin. May inhibit the butyrylcholinesterase-mediated metabolism of other substances.

Neurodegenerative Disease Drugs

N06DA03 - rivastigmine ; Belongs to the class of anticholinesterases. Used in the management of dementia.

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