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rivastigmine (Rx)Brand and Other Names:Exelon, Exelon Patch

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 1.5mg
  • 3mg
  • 4.5mg
  • 6mg

transdermal patch

  • 4.6mg/24hr
  • 9.5mg/24hr
  • 13.3mg/24hr
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Alzheimer Dementia

Oral

  • Indicated for mild-to-moderate dementia of the Alzheimer's type
  • Initial: 1.5 mg PO q12hr
  • Increase by 1.5 mg/dose q2Weeks; not to exceed 6 mg PO q12hr
  • Maintenance: 3-6 mg PO q12hr (higher end may be more beneficial)

Transdermal

  • Indicated for mild, moderate, and severe dementia of the Alzheimer's type
  • Initial: Apply 4.6 mg q24hr
  • Dose titration: May increase dose to 9.5 mg q24hr after a minimum 4 weeks if well tolerated; after an additional 4 weeks, may further increase to 13.3 mg patch if needed
  • Mild-to-moderate Alzheimer disease: Effective dosage range is 9.5-13.3 mg/24 hr
  • Moderate-to-severe Alzheimer disease: Effective dose is 13.3 mg/24 hr
  • Replace with new patch q24hr

Parkinson Dementia

Oral

  • Initial: 1.5 mg PO q12hr
  • Increase by 1.5 mg/dose q4Weeks; not to exceed 6 mg PO q12hr
  • Maintenance: 1.5-6 mg PO q12hr

Transdermal

  • Initial: Apply 4.6 mg q24hr
  • May increase dose to 9.5 mg q24hr after a minimum 4 weeks if well tolerated; after an additional 4 weeks, may further increase to 13.3 mg patch if needed

Dosage Modifications

Transdermal

  • Renal impairment: No dosage adjustment required
  • Mild-to-moderate hepatic impairment: Not to exceed 4.6 mg q24hr
  • Low body weight (<50 kg): Carefully titrate and monitor patients with low body weight for toxicities (eg, excessive nausea, vomiting), and consider reducing maintenance dose to 4.6 mg q24hr if toxicity develops

Administration

Take with food

Oral solution may be swallowed directly from provided syringe or mixed with small glass of fluid

Switching from oral to transdermal

  • If PO dose <6 mg/day, switch to 4.6 mg/24 hr patch
  • If PO dose is 6-12 mg/day, switch to 9.5 mg/24 hr patch

Not applicable

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Interactions

Interaction Checker

rivastigmine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Nausea (PO 47%; patch 21%)

            Vomiting (PO 31%; patch 6-19%)

            Dizziness (PO 21%; patch 2-7%)

            Diarrhea (PO 19%; patch 6-10%)

            Headache (PO 17%; patch 3-4%)

            Anorexia (PO 17%; patch 3-9%)

            Abdominal pain (PO 13%; patch 2-4%)

            1-10%

            Decreased weight (3-8%)

            Insomnia (PO 9%; patch 1-4%)

            Anxiety (PO 5%; patch 3%)

            Asthenia (PO 6%; patch 2-3%)

            Vertigo (2%)

            Fatigue (2%)

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            Warnings

            Contraindications

            Hypersensitivity to rivastigmine or carbamates

            History of application site reaction with transdermal patch

            Active GI bleeding

            Cautions

            Anorexia

            Sick sinus syndrome

            History of peptic ulcer

            History of asthma/COPD

            May induce/exacerbate extrapyramidal symptoms

            Concomitant NSAID

            Gastrointestinal adverse reactions may include significant nausea, vomiting, diarrhea, anorexia/decreased appetite, and weight loss, and may necessitate treatment interruption; dehydration may result from prolonged vomiting or diarrhea and can be associated with serious outcomes

            Medication errors with transdermal patches have resulted in serious adverse events; some cases have required hospitalization, and in rare instances, medication errors have led to death; most of the errors have involved not removing the old patch when putting on a new one and the use of multiple patches at the same time

            Skin application site reactions may occur with transdermal application and are usually mild or moderate in intensity; these reactions are not in themselves an indication of sensitization; however, use of rivastigmine patch may lead to allergic contact dermatitis

            Isolated postmarketing reports of disseminated hypersensitivity reactions of the skin irrespective of the administration route (oral or transdermal); treatment should be discontinued if disseminated hypersensitivity reaction of the skin occurs

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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Unknown if excreted in milk; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Reversible acetylcholinesterase inhibitor that causes an increase in concentrations of acetylcholine, which in turn enhances cholinergic neurotransmission

            Absorption

            Bioavailability: 36% (PO)

            Duration: 10 hr (PO); 24 hr (patch)

            Peak plasma time: 1 hr (PO); 8 hr (patch)

            Distribution

            Protein bound: 40%

            Vd: 1.8-2.7 L/kg

            Metabolism

            Metabolized by cholinesterase

            Elimination

            Half-life: 1.5 hr (PO), 3 hr (patch)

            Total body clearance: 1.2-2.4 L/min

            Excretion: Urine (97%)

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
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            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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