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Rivastigmine belongs to a family of medications known as cholinesterase inhibitors. It is used to treat symptoms of mild to moderate Alzheimer's disease. It is also used to treat mild to moderate dementia (problems with brain functions such as memory, language, and thinking) associated with Parkinson's disease.
Alzheimer's disease is caused by the constant degeneration of certain nerve cells in the brain that make a chemical called acetylcholine. This chemical is thought to be important for the processes of learning and memory. Parkinson's disease dementia is also believed to be related to a shortage of acetylcholine. Rivastigmine prevents the breakdown of acetylcholine, thereby increasing its levels in the brain. Rivastigmine provides the most benefit when there are enough cells producing adequate levels of acetylcholine (i.e., in mild to moderate disease) but provides little benefit when the disease becomes severe.
Rivastigmine may improve cognitive function (memory, orientation, and language) and general ability to perform activities of daily living. Rivastigmine may take up to 12 weeks to begin working, but individual response varies.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
1.5 mg Each yellow hard gelatin capsule, the strength (1.5 mg) and "Exelon" printed in red on the body of the capsule contains rivastigmine 1.5 mg (as rivastigmine hydrogen tartrate). Nonmedicinal ingredients: hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, and silicon dioxide; capsule: gelatin, red iron oxide and/or yellow iron oxide, and titanium dioxide.
3 mg Each orange hard gelatin capsule, the strength (3 mg) and "Exelon" printed in red on the body of the capsule contains rivastigmine 3 mg (as rivastigmine hydrogen tartrate). Nonmedicinal ingredients: hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, and silicon dioxide; capsule: gelatin, red iron oxide and/or yellow iron oxide, and titanium dioxide.
4.5 mg Each red hard gelatin capsule, the strength (4.5 mg) and "Exelon" printed in white on the body of the capsule contains rivastigmine 4.5 mg (as rivastigmine hydrogen tartrate). Nonmedicinal ingredients: hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, and silicon dioxide; capsule: gelatin, red iron oxide and/or yellow iron oxide, and titanium dioxide.
6 mg Each orange and red hard gelatin capsule, the strength (6 mg) and "Exelon" printed in red on the body of the capsule contains rivastigmine 6 mg (as rivastigmine hydrogen tartrate). Nonmedicinal ingredients: hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, and silicon dioxide; capsule: gelatin, red iron oxide and/or yellow iron oxide, and titanium dioxide.
Rivastigmine should not be taken by anyone who:
- is allergic to rivastigmine or to any of the ingredients of the medication
- is allergic to medications that are similar to rivastigmine
- has severely reduced liver function
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- accidental falls
- agitation or confusion
- constipation
- difficulty sleeping
- dizziness, sleepiness, or drowsiness
- headache
- gas
- increased sweating
- loss of appetite
- nausea, vomiting, diarrhea, or stomach discomfort after a meal
- trembling
- weakness, fatigue, or a general feeling of being unwell
- weight loss
- worsening of Parkinson's disease symptoms (e.g., stiffness or difficulty in carrying out movements)
Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- depression
- fainting
- hallucinations (seeing, feeling, or hearing things that are not there)
- high blood pressure
- skin rash or itching
- symptoms of a stomach ulcer (e.g., stomach pain, burning, discomfort, or bloating)
- symptoms of a urinary tract infection (e.g., painful or burning urination, frequent urination, or cloudy urine)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- blistering of the skin, mouth, eyes, or genitals
- blood in stools or when vomiting
- convulsions (seizures)
- fast, slow, or irregular heartbeat
- severe vomiting
- symptoms of a heart attack (e.g., pain, pressure, or discomfort in the chest, neck, back, or jaw; sweating; shortness of breath; nausea; lightheadedness; or feelings of anxiety, fear, or denial)
- symptoms of a stroke (e.g., sudden paralysis or numbness, difficulty speaking or understanding speech, loss of coordination, severe headache, or vision changes)
- symptoms of inflammation of the pancreas (e.g., severe stomach pain with nausea and vomiting)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
There may be an interaction between rivastigmine and any of the following:
- anticholinergic medications (e.g., benztropine, diphenhydramine, oxybutynin)
- antipsychotic medications (e.g., aripiprazole, chlorpromazine, haloperidol)
- beta-blockers (e.g., atenolol, metoprolol, propranolol)
- cholinergic medications (e.g., bethanechol)
- neuromuscular blocking agents (e.g., atracurium, pancuronium, succinylcholine)
- other cholinesterase inhibitors (e.g., donepezil, galantamine)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.
Breathing conditions: People with a history of asthma or obstructive lung disease (e.g., emphysema, chronic bronchitis) should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Drowsiness/reduced alertness: This medication may cause dizziness or drowsiness, mainly when starting treatment or increasing the dose. Your doctor will advise you whether it is safe for you to drive vehicles and operate machinery. If you feel dizzy or drowsy, do not drive, use machines, or perform any other tasks that require your attention.
Heart disease: People with certain types of heart disease (e.g., congestive heart failure, coronary artery disease) should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver and kidney function: People with reduced liver or kidney function who are taking this medication should be closely monitored by their doctors. People with severely reduced liver function should not use this medication.
Seizures: People using the rivastigmine patch have experienced seizures. People with a history of seizure should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Stomach problems: The use of rivastigmine is associated with significant stomach side effects including nausea, vomiting, loss of appetite, and weight loss. People with a history of stomach ulcers or are at risk of developing ulcers should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Stopping and restarting treatment: If you miss more than several days' worth of treatment, talk to your doctor about how to safely restart the medication.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if rivastigimine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children.
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