Rivastigmine (Oral Route)

Rivastigmine is a drug that is used to treat people with moderate to mild dementia, Parkinson’s disease and Alzheimer’s disease.

Overview

Rivastigmine is a drug that is used to treat problems such as memory loss, confusion and other mental changes in people who suffer from moderate to mild dementia, Parkinson’s disease and Alzheimer’s disease. Although rivastigmine will not cure any of these conditions or prevent them from developing, it can be extremely helpful in improving the clarity of thinking in some people.

One of the first noticeable symptoms in people who are affected by dementia and Alzheimer’s disease is confusion and loss of short-term memory. This effect is caused by chemical changes in the brain, notably a shortfall in the neurotransmitter - acetylcholine. Acetylcholine is necessary for the brain to function correctly.

Rivastigmine works by slowing the breakdown of acetylcholine, allowing it to build up in the brain, and therefore to have a greater effect. Unfortunately, as the disease progresses, the amount of acetylcholine produced in the brain will become further reduced, until rivastigmine stops working as effectively.

In the US, rivastigmine is sold under the brand name, Exelon. The drug can only be obtained through a prescription from your GP or specialist. Exelon is available in capsule or solution form to be taken orally.

Conditions Treated

  • Alzheimer’s disease
  • Parkinson’s disease
  • Dementia

Type of medicine

  • Oral solution
  • Oral capsule

Side Effects

Rivastigmine has many benefits to patients, but it can also cause unwanted side effects in some people who are taking it as part of their treatment regimen. You may not experience any side effects whatsoever while taking rivastigmine, but if you do notice any of the effects that are noted below, you should mention them to your doctor immediately.

  • Weight loss
  • Vomiting of blood or debris that resembles coffee grounds
  • Uncontrolled movements, especially of the back, face and neck
  • Twisting motions of the body
  • Stiffness of limbs
  • Shortness of breath
  • Shaking and trembling of the hands and fingers
  • Severe stomach pains
  • Restlessness
  • Problems with speaking
  • Problems urinating
  • Nausea and vomiting
  • Muscle trembling, stiffness or jerking
  • Loss of strength
  • Loss of balance control
  • Loss of appetite
  • Irregular or slow heartbeat
  • Indigestion
  • Feeling unusually tired
  • Feeling lightheaded, dizzy or faint
  • Fainting
  • Drooling
  • Diarrhea
  • Convulsions
  • Constipation
  • Chest pains or other discomforts
  • Black, bloody or tarry stools
  • Aggression
  • A shuffling gait

If you suffer any of the following symptoms, you may have taken too much of the medication. In these circumstances, call 911 immediately:

  • Shallow, irregular, fast or slow breathing
  • Severe vomiting
  • Severe nausea
  • Seizures
  • Irregular or slow
  • Increased watering of the mouth
  • Increased sweating
  • Feeling unusually tired
  • Fainting, lightheadedness or dizziness
  • Cyanosis
  • Chest discomfort or pain
  • Breathing problems

There are some effects that can be caused by rivastigmine that do not generally mean that you will need to see your doctor. These effects usually sort themselves out as your body gets used to the medicine. In addition, your treating specialist will be able to suggest a few ways in which you can reduce or prevent some of these unwanted effects. However, if you find that you are struggling to cope with the less desirable effects of the medication, check with your doctor.

  • Runny nose
  • Insomnia
  • Headache
  • Hallucinations
  • Feeling generally unwell or in discomfort
  • Feeling bloated or full
  • Dizziness
  • Depression
  • Confusion
  • Abdominal cramps or pains in the stomach

There may be some side effects that you notice that are not listed here. Always seek medical advice if you begin to experience any other bad reactions to this medicine.

Dosage

You must use this medicine exactly as instructed by your GP. Do not take more rivastigmine than you have been told to, or take it more frequently. Also, you must not extend your course of treatment with this drug without first obtaining approval from your GP.

Your prescription will be dispensed to you with written instructions. Read all the notes carefully and make sure that you understand everything they contain. If you have any queries, ask your GP or the pharmacist.

For best results and to avoid feelings of nausea, you should take this medication with a meal or snack.

In order to keep stable levels of rivastigmine in your body and to ensure a constant effect, it is advised that you take your medication at the same time each day, one in the morning and again in the evening.

To take the oral liquid:

Use the dosing syringe that is supplied with the drug to measure out the exact prescribed dose. Swallow the liquid straight from the syringe or mix it with a small glass of fruit juice, soda, or water. The mixture will be usable for up to four hours. Avoid mixing the drug with hot drinks.

To take the liquid capsules:

The capsules must be swallowed as they are, without chewing, sucking, breaking or crushing them first.

The dose of rivastigmine prescribed will not be the same for every patient. You should take the amount of the drug that you have been prescribed by your GP or follow the instructions on the dispensary label. This guide contains only the average dose for this medication. If you have been told to take a different dose, you should not alter it unless you are instructed to by your treating specialist.

Your dose of rivastigmine will to some extent depend on the potency of the preparation you are given. The total doses that you must take daily may also vary, as will the space that you leave between them. In addition, the duration of your course of treatment will be dependent on the health condition that you are being treated for.

For patients taking oral capsules – Alzheimer’s disease

  • Adults: To begin with, take 1.5 mg twice daily. Your treating specialist might increase this amount gradually, depending on how you react to the drug. Generally, you will not take more than 6 mg twice daily.
  • Children: Your child’s doctor will decide on the appropriate use of the medication.

For patients taking oral capsules – Parkinson’s disease

  • Adults: To begin with, take 1.5 mg twice daily. Your specialist might increase this amount gradually, depending on how you react to the drug. Generally, you will not take more than 6 mg twice daily.
  • Children: Your child’s doctor will decide on the appropriate use of the medication.

If you forget to take one dose of your prescribed rivastigmine, you should try to take it as soon as you can. Do not, however, take twice the amount to make up for your omission. Instead, miss out one dose and then pick up your usual dosing schedule. If over three days have elapsed since your last dose, contact your doctor immediately. It may be necessary for you to start your course of treatment again with a lower dose.

Interactions

Some medicines should not be used in conjunction with rivastigmine, doing so may cause an interaction to take place. However, your doctor may decide to combine rivastigmine with one or more other drugs if this is the best option for your treatment. In this case, you may find that your dosage rates have been changed.

All the drugs listed below can cause interactions or increased side effects if they are used with rivastigmine. If you are taking any of these medicines, your doctor may adjust your dose or suggest an alternative.

  • Timolol
  • Sotalol
  • Propranolol
  • Practolol
  • Pindolol
  • Penbutolol
  • Oxprenolol
  • Nebivolol
  • Nadolol
  • Metoprolol
  • Metoclopramide
  • Metipranolol
  • Levobunolol
  • Labetalol
  • Esmolol
  • Donepezil
  • Celiprolol
  • Carvedilol
  • Carteolol
  • Bupropion
  • Bromopride
  • Bisoprolol
  • Betaxolol
  • Atenolol
  • Acebutolol
  • Oxybutynin
  • Tolterodine

It can also cause an interaction if you eat certain foodstuffs, use tobacco or drink alcohol when using some medicines. Have a chat with your doctor with regards to the use of tobacco, alcohol and the consumption of certain food groups to ensure that there will not be any danger of an interaction while you are taking rivastigmine.

Warnings

You should tell your treating physician if you have ever experienced any allergic or unusual reactions to rivastigmine or any other prescription drug. In addition, tell your doctor if you have allergies to particular food groups, preservatives, animal derivatives or food colourings. You must include in your list any non-prescription products, including cough and cold remedies, herbal supplements and vitamins.

You must attend your doctor regularly for progress checks. At these visits, your GP will assess if the medication is being fully effective and will also make sure that you are not suffering from any side effects.

You may find that rivastigmine causes vomiting, diarrhea, nausea, poor appetite, stomach discomfort or weight loss. If you do experience any of these effects, you must tell your GP, as these complications can cause additional issues such as dehydration.

If you notice that you have developed hives or a rash on your skin while taking rivastigmine, you should desist with the drug and speak to your treating specialist as a matter of urgency.

Rivastigmine can sometimes cause interactions with the drugs used during surgery or dental treatments. Before you undergo any form of surgery, emergency treatment or dental treatment, be sure to tell the person in charge of your case that you are currently using rivastigmine.

This medication can cause some patients to feel dizzy. Some people also report that they become unsteady on their feet or clumsy. If you are affected in this way, do not drive, use machinery or take part in any other form of activity that necessitates you being fully alert.

If you stop taking rivastigmine suddenly, you may experience severe mental or behavioural changes. Before reducing your dose or stopping the medication altogether, you must check with your treating specialist.

In the event of you or someone in your household taking too much rivastigmine, you may note the following symptoms:

  • Dilated pupils in the eyes
  • Erratic breathing
  • Convulsions
  • Shock
  • Rapid, weak pulse
  • Severe nausea
  • Vomiting
  • Profuse sweating
  • Watering of the mouth or drooling
  • Worsening muscle weakness

If you think that someone has taken an overdose of rivastigmine, summon emergency medical assistance immediately by calling 911.

There are a number of other medical conditions that can affect how rivastigmine works. You must remember to tell your doctor if you have any other health conditions, especially those discussed below.

If you have ever suffered an adverse skin reaction to rivastigmine transdermal patches, you should not use the oral version of this medication.

Using rivastigmine with any of the following common health conditions can make them worse:

  • Asthma
  • Heart problems, including low blood pressure
  • Breathing or lung problems, including COPD
  • Seizures
  • Bowel or stomach problems, including ulcers
  • Urinary tract problems, including blockages or difficulty with urination

Tell your doctor if you have any history of these problems.

A lower dose of rivastigmine should be used in patients who have a current or previous history of liver or kidney disease.

There is no evidence to suggest that rivastigmine can present a danger to the fetus. However, if you are pregnant or thinking of trying to become pregnant while you are being treated with this drug, you should discuss the pros and cons of using it with a trained health professional, before you start taking it.

Similarly, there are no studies to show that rivastigmine can pass into breast milk. However, if you are breastfeeding, you should ask your GP or midwife for more advice. You may wish to discontinue breastfeeding your infant until you have completed your treatment with the medication and use an alternative nutrition source instead.

Rivastigmine can cause intestinal bleeding or bleeding in the stomach if taken together with some non-prescription medications such as ibuprofen or naproxen. You may take a low dose of aspirin if your doctor has recommended that you do, in order to treat specific medical conditions such as stroke or heart attack prevention. The usual acceptable dose of aspirin for use with rivastigmine is 81 to 325 mg daily.

Storage

Your supply of rivastigmine capsules or oral solution should be kept in a sealed container and at room temperature. Do not leave the medication where it could be exposed to direct sunlight or other sources of heat. Do not allow the medicine to get wet.

The medication is not suitable for refrigeration or freezing.

Keep the medicine well away from young children and pets. If your child takes any of your drugs, seek emergency medical attention immediately. If a pet consumes rivastigmine, you should speak to your emergency vet as soon as possible.

Do not use any of your medication that has become out-of-date. Discard any medicine with packaging that appears to have been damaged or previously opened.

When it comes to disposing of unwanted medication, do so responsibly. Do not pour unused rivastigmine solution down the drain or into the toilet. Wrap unwanted capsules in a sealed bag and place them in the bottom of your garbage can, where children and animals cannot easily access them.

If you are in any doubt about how to safely get rid of unwanted drugs, ask your pharmacist for advice.

Summary

Rivastigmine is a drug that is widely used in the management of problems such as memory loss, confusion, and certain other mental changes that may be experienced by patients who are suffering from Parkinson’s disease, moderate to mild dementia, and Alzheimer’s disease. It should be noted that rivastigmine will not provide a cure for any of these conditions, nor will it prevent them from progressing. However, this medication is extremely helpful in improving the clarity of thinking in some people.

Despite the many benefits that can be provided by rivastigmine, it can cause a wide range of side effects. Treatment with this medication can also exacerbate some existing and historical health conditions. There is a long list of drugs that should not be used in combination with rivastigmine as dangerous or unpleasant interactions can occur. For these reasons, it is very important that patients remember to attend regular appointments with their treating specialist or GP so that the effect of treatment can be monitored and changes to dosage levels made if necessary.

 

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Last Reviewed:
January 31, 2018
Last Updated:
February 10, 2018