Rivastigmine

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Generic Name: Rivastigmine Brand Name(s): Generics only. No brands available.

Uses

What is Rivastigmine used for?

Rivastigmine is used to treat confusion (dementia) related to Alzheimer’s disease and to Parkinson’s disease. Rivastigmine does not cure either of these diseases, but it may improve memory, awareness, and the ability to perform daily functions. This medication works by restoring the balance of natural substances (neurotransmitters) in the brain.

How should I take Rivastigmine?

Take this medication by mouth with food as directed by your doctor, usually twice daily in the morning and evening. Dosage is based on your medical condition and response to treatment. To reduce your risk of side effects (such as nausea and diarrhea), your doctor will start this medication at a low dose and gradually increase your dose over 2 to 4 weeks. The maximum recommended adult dose is 6 milligrams twice a day.

Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same times each day. Do not stop taking it unless your doctor instructs you to do so. Do not use this drug more often than prescribed.

If you do not take rivastigmine for 3 or more days in row, talk with your doctor before starting again. You may need to restart at a lower dose.

Tell your doctor if your condition worsens.

How do I store Rivastigmine?

Rivastigmine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Rivastigmine in the bathroom or the freezer. There may be different brands of Rivastigmine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Rivastigmine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Rivastigmine?

Before taking rivastigmine, tell your doctor or pharmacist if you are allergic to it (including having a rash while using rivastigmine patches); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: breathing/lung problems (such as asthma, COPD-chronic obstructive pulmonary disease), stomach/intestinal problems (such as ulcers, bleeding), heart disease (such as sick sinus syndrome, other conduction disorders), fainting, seizures, problems urinating (such as due to enlarged prostate).

This drug may make you dizzy or drowsy. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Rivastigmine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Rivastigmine. Rivastigmine is pregnancy risk category B according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Rivastigmine?

Nausea, vomiting, loss of appetite/weight loss, diarrhea, weakness, dizziness, drowsiness, and shakiness (tremor) may occur as your body adjusts to the drug. These effects usually occur when you start the medication or increase the dose and then lessen. If any of these effects persist or worsen, contact your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these serious side effects occur: slow/irregular heartbeat, fainting, black stools, vomit that looks like coffee grounds, severe stomach/abdominal pain, seizures, trouble urinating.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Rivastigmine?

Some products that may interact with this drug include: aspirin/nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen, naproxen), metoclopramide.

Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (NSAIDs such as aspirin, ibuprofen, or naproxen) that if taken together with rivastigmine may increase your risk for stomach/intestinal bleeding. Low-dose aspirin, as prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention (usually at dosages of 81-325 milligrams per day), should be continued. Consult your doctor or pharmacist for more details.

Rivastigmine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Rivastigmine?

Rivastigmine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Rivastigmine?

Rivastigmine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Rivastigmine.

What is the dose of Rivastigmine for an adult?

Usual Adult Dose for Alzheimer’s Disease

MILD TO MODERATE ALZHEIMER’S DISEASE:

ORAL:

-Initial dose: 1.5 mg orally twice a day

-Maintenance dose: After a minimum of 2 weeks of treatment, if the initial dosage is well tolerated, it can be increased to 3 mg twice a day; subsequent increases to 4.5 mg and 6 mg twice a day should be attempted only after a minimum of 2 weeks at the previous dosage

TRANSDERMAL PATCH:

-Initial Dose: 4.6 mg/24 hour patch applied to the skin once daily

-Maintenance Dose: After a minimum of 4 weeks of treatment at the initial dose, and if well tolerated, the dose can be increased to 9.5 mg/24 hours for as long as this dose is beneficial; the dose can then be increased to 13.3 mg/24 hours

-Maximum Dose: 13.3 mg/24 hour patch applied to skin daily; higher doses confer no appreciable additional benefit, and are associated with significant increase in the incidence of adverse events

SEVERE ALZHEIMER’S DISEASE:

TRANSDERMAL PATCH:

-Recommended dose: 13.3 mg/24 hours transdermal patch applied to skin once daily; replace with a new patch every 24 hours

Use: For the treatment of mild, moderate, or severe dementia of the Alzheimer’s type (AD)

Usual Adult Dose for Parkinson’s Disease

MILD TO MODERATE PARKINSON’S DISEASE DEMENTIA:

ORAL:

Initial dose: 1.5 mg orally twice a day with morning and evening meals

Maintenance dose: Subsequently, the dose can be increased to 3 mg orally twice a day and further to 4.5 mg twice a day and 6 mg twice a day (based on tolerability) with a minimum of 4 weeks at each dose

TRANSDERMAL PATCH:

Initial dose: 4.6 mg/24 hours applied to the skin once a day

Maintenance dose: After a minimum of four weeks of treatment and if well tolerated, the dose of the patch can be increased to 9.5 mg/24 hours for as long as this dose is beneficial. The dose can then be increased to 13.3 mg/24 hours.

Maximum dose: 13.3 mg/24 hours. Higher doses confer no appreciable additional benefit, and are associated with significant increase in the incidence of adverse events.

Use: For the treatment of mild to moderate dementia associated with Parkinson’s disease

Renal Dose Adjustments

No dosage adjustment recommended, because the dose is individually titrated to tolerability.

Moderate to severe renal impairment (glomerular filtration rate less than 50 mL/min): Patients may only be able to tolerate lower doses

Liver Dose Adjustments

-Mild (Child-Pugh 5 to 6) and moderate (Child-Pugh 7 to 9) hepatic impairment: The dose may need to be lowered

-Severe hepatic impairment: Data not available

Dose Adjustments

Interruption of therapy with transdermal patches:

-If dosing interrupted for 3 days or fewer, restart treatment with the same or lower strength transdermal patch.

-If dosing is interrupted for more than 3 days, restart treatment with the 4.6 mg/24 hours transdermal patch and titrate

Dosing Modifications in Patients with Low Body Weight:

-Carefully titrate and monitor patients with low body weight (less than 50 kg) for toxicities (e.g., excessive nausea, vomiting), and consider reducing the dose if such toxicities develop.

If adverse effects (e.g., nausea, vomiting, abdominal pain, loss of appetite) cause intolerance during treatment, the patient should be instructed to discontinue treatment for several doses and then restart at the same or next lower dosage level.

Switching to Patch from Capsules or Oral Solution:

-A patient who is on a total daily dose of less than 6 mg orally can be switched to patch dose of 4.6 mg/24 hours.

-A patient who is on a total daily dose of 6 to 12 mg orally can be directly switched to a patch dose of 9.5 mg/24 hours.

-It is recommended to apply the first patch on the day following the last oral dose.

Other Comments

Administration advice:

ORAL:

-Take with meals in divided doses in the morning and evening.

-The oral solution may be swallowed directly from the syringe or mixed with a small glass of water, cold fruit juice, or soda.

PATCHES:

-Do not use the patch if the pouch seal is broken or the patch is cut, damaged, or changed in any way.

-Apply the patch once a day.

-Press down firmly for 30 seconds until edges stick well.

-Use upper or lower back as the site of application.

-Do not apply to skin area where cream, lotion, or powder has been recently applied.

-Do not apply to skin that is red, irritated, or cut.

-Wear one patch at a time.

-Change site of application daily, do not apply a new patch to same location for at least 14 days.

-May wear patch during bathing, but avoid long exposure to external heat sources.

Storage requirements:

-Keep transdermal patch in the individual sealed pouch until use

-Store oral solution in an upright position and protect from freezing

-Oral solution is stable at room temperature for up to 4 hours when mixed with cold fruit juice or soda.

General:

-The oral formulation is not indicated for severe dementia of the Alzheimer’s type.

Patient advice:

-Used transdermal patches should be folded, with the adhesive surfaces pressed together and discarded safely.

-Avoid eye contact and wash hands after handling the transdermal patch.

What is the dose of Rivastigmine for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Rivastigmine available?

Rivastigmine is available in the following dosage forms and strengths:

  • Oral capsule,
  • Oral solution,
  • Transdermal film, extended release.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Rivastigmine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: April 25, 2018 | Last Modified: April 25, 2018

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