Rivastigmine (Transdermal)

Rivastigmine is often used to prevent or lessen the symptoms of Alzheimer's and Parkinson's disease.

Overview

While this drug does not serve as a cure to dementia, it is used to treat symptoms and improve the patient's quality of life. It can reduce confusion, improve memory, and allow the patient to better perform daily functions. This medication works by inhibiting the breakdown of acetylcholine, which helps the brain function fluidly. This process forces the brain to retain ACh, which results in increased function and awareness.

This drug should not be used in cases where the patient is already suffering from severe dementia, as they may not be producing enough natural acetylcholine to benefit from the drug. However, in cases where the patients are still producing this chemical, this drug can encourage increased brain function.

This drug has several side effects, including nausea and vomiting. These side effects can be reduced by using the transdermal form of the drug, which is expanded upon here. Users that take the oral form may experience more digestive side effects.

The transdermal patch may cause itching, but it should be removed if a rash or persistent burning occurs. While this drug should not cause any severe side effects, a patient may experience allergy symptoms or adverse reactions. In these cases, remove the patch, wash the area thoroughly, and contact your doctor. Do not re-apply the patch if you experience adverse effects the first time.

The patch should be replaced once a day, and the size and dosage of the patch may vary depending on the patient. Talk to your doctor for more information on your treatment if you have questions, concerns, or are considering Rivastigmine as a treatment option. Do not apply more than one patch, and always remove the previous patch before using another. Wash your hands after applying the patch, and do not touch your eyes if you've recently had contact with the medication.

This drug comes with warnings and may interact with other medications. Only use this drug if you have full approval from your doctor, and do not use it off-prescription. User discretion is advised, especially in cases where the patient requires a caregiver. Caregivers should keep a close eye on their charge to make sure that they are not reacting negatively to their Rivastigmine treatment.

This drug is not for everyone. While it can serve as a valuable medication for those suffering from dementia, it is not a cure-all for Alzheimer's or Parkinson's. Talk to your doctor if you plan on using Rivastigmine, or plan on using it on a family member/charge. Only use this medication as directed, and follow the instructions carefully for every use. Do not continue this medication if you or your charge experience allergy symptoms or adverse reactions.

Conditions Treated

  • Dementia caused by Alzheimer's disease
  • Dementia caused by Parkinson's disease

Type of Medicine

  • Acetylcholinesterase (ACh) inhibitor

 

Side Effects

This medication may cause side effects, especially if you have never used a Rivastigmine patch before. While the patch (transdermal) form of this drug has been reported to cause fewer side effects, there are form-specific side effects to look for when using the patch. Common side effects of Rivastigmine and the Rivastigmine patch include:

  • Nausea and vomiting, although these side effects were less recorded when using the patch.
  • Loss of appetite
  • Dizziness
  • Weight loss
  • Drowsiness
  • Mild irritation at the patch site
  • Shakiness or tremors

These side effects are largely harmless, but they should be recorded and monitored closely. If they persist or worsen, contact your doctor. Do not halt your treatment unless you feel it is completely necessary. These side effects may lessen or disappear entirely the longer you use this medication. You should also remember that your doctor is prescribing this drug in your best interest. Chances are, the benefits of this drug far outweigh those of an untreated lifestyle.

Some side effects are more dangerous. These may be symptoms of a larger problem, so stop using the patch and contact your doctor immediately if they occur:

  • Fainting
  • Bloody vomit or stool
  • Severe stomach/abdominal pain
  • Seizures
  • Slowed heartbeat
  • Trouble urinating

These side effects may be a sign that your body is reacting adversely to the drug. They may also be a sign that the drug is aggravating an existing condition. Remove the patch, wash the area with mild soap and warm water, and contact your doctor immediately. If you believe your life is in danger, contact emergency services. Do not continue using this drug, and do not switch to the oral form of this medication. Caregivers should monitor their charges closely for any of these symptoms.

While rare, some patients may experience allergic reactions to the Rivastigmine patch. Allergies can become fatal, and symptoms should not be ignored. If you or a charge experience allergy symptoms, they may be allergic to Rivastigmine itself or the inactive ingredients within the patch. Remove the patch, wash with warm water and soap, and talk to your doctor about other forms of treatment.

Allergy symptoms include:

  • Rash, burning, and severe itching at the application site
  • Unexplained fever
  • Swelling of the face, extremities, or application site
  • Trouble breathing
  • Severe dizziness

While this list contains some of the most common side effects, it is not complete. Some patients react unexpectedly to a new medication, and no side effects should be ignored. If something seems out of the ordinary, contact your doctor as soon as possible. The internet can be a valuable resource, but your doctor should be your first and most reliable source of information.

Dosage

Dosage can vary depending on the severity of your condition. However, the application and guidelines for Rivastigmine patches don't change from patient to patient. If you would like more information on how to use your Rivastigmine patch, contact your doctor or pharmacist for more information. Here are some general guidelines on how to use this patch:

  • Read the instructions carefully and thoroughly, or have someone else read them to you. Your doctor, pharmacist, or caregiver will likely explain them to you if you are confused. If you need help, they can assist in applying the patch.
  • Do not open the package until it is time to use the patch. Opening the pouch too early may reduce the efficacy of the medication.
  • Apply the patch to a hairless place on your chest, upper arm, or back. Do not apply this patch to broken or irritated skin and do not use this patch on areas where you have recently applied lotion or medication creams.
  • You can bathe with this patch on, but try to apply it after showers to reduce the chances of it peeling off.
  • Do not wear two patches at once.
  • Only replace the patch when prescribed. Do not replace more than once a day.
  • Do not wear this patch for longer than prescribed.
  • Apply your patches to different areas to reduce irritation. Rotate where you put them on a day-to-day basis.
  • Always wash your hands after using this patch, and do not touch your eyes after applying it. Neglecting to wash the medication residue off your hands may cause irritation.
  • If a patch falls off before your next dose, apply a new one and continue your normal schedule.

Your doctor may start you on a lowered dose of Rivastigmine until you adjust to the medication. From there, they may increase the potency of your patches until you've reached the desired dose. If you stop taking this medication for three or more days, you may need to go back to a lowered dose and ramp back up to your recommended dose. Talk to your doctor if you've missed several doses.

The recommended dose for moderate dementia in cases of Alzheimer's or Parkinson's is 9.5mg per day, absorbed through the skin via a patch. Your doctor may start you on a 4.6mg dose until you adjust to the medication, and ramp up your dose until you're at the desired amount. Severe dementia may be treated with doses up to 13.3mg per day, but doses higher than this should only be given with explicit doctor approval.

Monitoring for overdose should be taken seriously. Symptoms of Rivastigmine overdose include:

  • Severe, persistent nausea and vomiting
  • Fainting or loss of consciousness
  • Slow, shallow breathing
  • Seizures
  • Abnormal heartbeat
  • Excessive sweating

If these symptoms occur, contact poison control or call 911 for medical assistance. Caregivers should keep a close eye on their charges for signs of overdose, especially if the patient is in charge of applying the patch themselves. Some patients may apply their patch, forget, and apply another. This can result in an overdose. If your charge seems confused or forgetful about their treatment, start applying their medication yourself and contact a doctor.

Interactions

This drug may interact with other medications, causing troublesome or dangerous effects. Be sure to tell your doctor about every medication you are taking, including herbal supplements, vitamins, and over the counter drugs. Your doctor will determine if it is safe for you to take this medication. They may change or lower your other medications so you can take Rivastigmine safely. Follow their directions closely, and only take Rivastigmine as directed.

Common interactions can include:

NSAIDs like ibuprofen, naproxen, and aspirin. These can come in prescription or over the counter forms. Be sure to let your doctor know how often you take NSAIDs, and how many you take each time. NSAIDs may increase your likelihood of internal bleeding. If you are taking NSAIDs as a treatment for stroke or heart attack prevention, you will likely be able to continue your prescription without issue.

Not all possible interactions are listed here. Be sure to inform your doctor if you are taking additional medications, and always follow their professional opinion.

Warnings

Rivastigmine comes with warnings that should be regarded carefully by anyone who is considering Rivastigmine. Inform your doctor if you experience/have experienced:

  • Heart problems
  • Lung problems (asthma, trouble breathing, COPD)
  • Stomach problems (ulcers or bleeding)
  • Liver disease
  • Fainting
  • Seizures
  • Any previous allergies to Rivastigmine, drugs of that type, or the inactive ingredients in the adhesive patches.

You should also beware of the potential issues with Rivastigmine patches, which include:

  • Reactions to heat. Heating blankets, prolonged contact with sunlight, saunas, hot tubs, or heaters can cause the patch to release more medication than recommended. The sudden influx of medication can aggravate side effects, including vomiting and nausea.
  • Dangers during MRI scans. Inform your physician that you are wearing a Rivastigmine patch before receiving an MRI. The machine can interact with any metals in the patch and cause serious burns. Be sure to remove any and all patches before entering an MRI machine, and caretakers should keep this in mind if the patient does not.
  • Drowsiness and dizziness are common on this drug. You should not drive or operate machinery until you know exactly how this drug affects you. Ask someone else to drive you, or get a taxi if you begin to feel dizzy or sleepy behind the wheel. If your doctor increases your dose, avoid driving until you know how the added medication will affect you.
  • This drug should only be used during pregnancy with doctor approval. Careful monitoring of the mother and child is recommended when using this drug during pregnancy. It is not known if this drug passes into breastmilk, so only breastfeed if told to do so. Otherwise, look into formulas or other forms of treatment.
  • Tell your doctor, surgeon, or dentist if you need surgery while on this drug. It may interact with the anesthetics used during surgery. If necessary, stop using this drug before your surgery and resume your prescription after the operation is over. Talk to your doctor to see how long you soon you need to stop your medication before the surgery.
  • Avoid alcohol on this medication. Alcohol can encourage loss of memory and confusion, which affects how well this drug will work. Talk to your doctor if you or your charge drinks regularly.

Warnings are there to protect you and your charge from potential dangers. All drugs come with risks when taken, and you should be fully aware of the effects this drug may have on you. Use Rivastigmine patches carefully, and only use this medication as directed. Contact your doctor if you have questions or concerns about how this drug will affect you.

Storage

Rivastigmine patches should be stored in a cool, dry place until it is time to use them. Heat may change the efficacy of this drug, so make sure that you put them in a cool part of your home. Water may damage the adhesive patch, so do not expose them to water before application. Water may affect how well the patch sticks to your body, so limit how long you bathe while using this patch. Do not take hot baths or showers, as it may increase the absorption of this drug and cause an increase in side effects.

Do not open the packaging of this drug until it is time to use it. Opening the package too early may reduce how well it works when it is used. Once you are done with a patch, stick the sides together and throw it away. Wash your hands before and after handling the patch, and do not touch your eyes. The medication may cause irritation if you touch sensitive areas without washing it off.

Do not eat this patch. It is meant for topical use only. Throw this patch away where no pets or children can get it, and do not leave it in places where children or pets can reach it. If consumed, contact poison control for more information on how to proceed. Present them with your prescription and all the information you have on the drug. Only store and use this drug as directed, and do not give your patches to anyone else. Even if they have the same/similar symptoms as you, they may react negatively to this drug and its active/inactive ingredients.

Throw the used patches away with the rest of your garbage. If you have leftover medication after your prescription is finished, do not take it. Do not keep the medication, and throw it away normally. If you can, look for medication take-back programs hosted by local hospitals or doctor's offices. If this drug has expired, throw it away. Never use expired medication. It may have negative effects, no effect, or decreased effects.

If you have a question on how to store this drug, talk to your doctor or pharmacists. Caregivers should put this drug somewhere safe, especially if their charges forget if/when they have taken their medication. Unmonitored charges may try to apply more than one patch and accidentally overdose. If overdose is suspected, contact poison control or emergency medical services immediately.

Summary

Introduced in 1997, Rivastigmine has been administered and marketed as a popular treatment for dementia for over eighteen years. Rivastigmine patches were the first of their kind and paved the way for many of the patch treatments for dementia. Rivastigmine patches are also sold as 'Exelon' patches.

This drug treats confusion in both Alzheimer's and Parkinson's patients and is recommended by a number of doctors to treat these diseases. While they cannot cure these conditions or stop them from progressing, they can make life easier for the patients, their caregivers, and their families.

While this drug comes with a number of side effects, the benefits of this drug far outweigh the negative impacts of the side effects in question. However, if the side effects become severe or troubling, contact your doctor for more information. Only use this drug if you are advised to do so. Neglecting to follow your doctor's instructions can result in harm to you or your charge. Use this drug as directed, and watch for signs of overdose or adverse reaction.

Allergies to this drug are rare, but some allergic reactions have been recorded. If you have an allergy to latex, adhesive, or Rivastigmine itself, talk to your doctor before beginning your prescription. You may require the oral form of this drug, or a different medication entirely. Allergies should be taken seriously, and if you experience allergy symptoms, stop using the patch and contact your doctor immediately.

Wash your hands after using this drug. Do not touch your eyes if you've recently applied a Rivastigmine patch, as the leftover medication or residue may irritate sensitive areas. If you experience severe irritation or rash, take off the patch and wash the area thoroughly with warm water and mild soap. Avoid strong soaps, as they may aggravate the irritation.

If you think you or a loved one may benefit from Rivastigmine treatment, bring it up with your doctor. There are many factors that go into choosing a dementia treatment, so your doctor should be involved in the discussion. Every person requires slightly different care, so make sure that your treatment fulfills your unique needs. If you have questions or concerns about your treatment, talk to your doctor. While the internet can be helpful, your online research should be strictly supplemental. Your doctor should be your first and last source of accurate, personalized information.

 

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Last Reviewed:
February 01, 2018
Last Updated:
January 27, 2018