Drug Facts: Exelon (rivastigmine)

August 3, 2010

Generic name: rivastigmine

Available as a dermal patch in 4.6 mg/24 hour (9mg total) dose or 9.5 mg/24 hour (18 mg total) dose or as 1.5 mg (yellow), 3 mg (orange), 4.5 mg (red), and 6 mg (orange and red) capsules. Also available as a liquid for those who cannot swallow pills.

Why It’s Prescribed
To ease the symptoms of mild to moderate Alzheimer’s. Improves, maintains, or slows the decline in thinking skills and overall ability to perform daily activities of living, such as dressing, eating, or handling mail. However, it does not halt disease progression long-term.

Who Benefits
People with mild to moderate Alzheimer’s disease. About half of patients who try the drug show slight improvement. May be a particularly good choice for those with rapidly progressing disease.

How it Works
Slows the breakdown of acetylcholine, a chemical that aids memory by transmitting messages between brain cells.

Dosage Guidelines
Patch- To start: 4 weeks on 4.6 mg/24 hour to establish tolerance for the drug before increasing to 9.5mg/24 hour. Patch is applied to back, chest, or upper arm.
Capsule- To start: 1.5 mg twice a day. Your doctor may increase the dose every two weeks, or less often. Average daily dose: 6 to 12 mg, taken in divided doses with food once in the morning and once at night. The liquid form may be swallowed from a syringe or mixed with water, soda or juice; caregivers should be instructed on administration.

Onset of Effect
Benefits, if they occur, may appear within several weeks of starting the drug.

Store in a tightly sealed container away from heat, moisture and light. Do not freeze the liquid form.

Missed Dose
Patch- Apply the patch as soon as you remember, then apply the next patch at the regular time the following day.
Capsule/Liquid- Take the dose as soon as you remember, or skip the dose and resume your usual schedule if it’s within two hours to your next dose. If treatment has been missed for several days or longer, consult your doctor: You may need to resume the drug at a lower dose to avoid vomiting and other side effects.

Long-term Use
The drug is taken long term and may move the clock back a few months, but the disease continues to progress. If the drug seems to stop working, your doctor may switch you to another Alzheimer’s drug.

Side Effects
Serious: Possible bleeding in the stomach or bowel.
Most common: Nausea, vomiting, weight loss, upset stomach, muscle weakness.
Less common: Heartburn, weakness, dizziness, diarrhea, abdominal cramps. Sweating, fatigue, headaches, tremors, anxiety, depression, insomnia may also occur.

Precautions & Special Concerns
If you are going to have surgery, a dental procedure, or emergency treatment, let your doctor know you are taking this drug. Do not drive until you see how the medicine affects you, since it may cause drowsiness.

In Case of Overdose: Symptoms & What to Do
Severe nausea or vomiting, increased salivation, sweating, slowed heartbeat, low blood pressure, irregular breathing , unconsciousness, muscle weakness. Call your doctor, emergency medical services, or poison control center immediately.

Drug Interactions
Patch: Other cholinomimetic drugs, anticholinergic medications, and succinylcholinetype muscle relaxants during anesthesia may cause complications.
Nonsteroidal anti-inflammatory drugs (NSAIDs), commonly taken for arthritis and pain relief, may increase the likelihood of bleeding problems or ulcers in those taking this drug. Antihistamines, antipsychotic drugs, and some drugs for incontinence may also diminish its effects.

Food Interactions
No known food interactions. Avoid alcohol while using this drug.

Disease Interactions
Consult your doctor if you have asthma, epilepsy or seizures, heart disease, an ulcer, liver or bowel disease, or urinary tract problems.

Expert comment
“For some people with Alzheimer’s disease, this drug can lead to improvements that the family can see. In others, responses may only be detectable under special testing conditions, or there may be no measurable response at all. It is important that family members and physicians maintain realistic expectations for drug therapy and remember that, as with all current Alzheimer’s drugs, responses are generally only modest at best.” –Samuel E. Gandy, M.D., Ph.D., Scientific Advisory Board, Fisher Center for Alzheimer’s Research Foundation


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