rivastigmine (Rx)

Brand and Other Names:Exelon, Exelon Patch
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 1.5mg
  • 3mg
  • 4.5mg
  • 6mg

transdermal patch

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

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

Interruption of treatment (Oral)

  • If adverse effects (e.g., nausea, vomiting, abdominal pain, loss of appetite) cause intolerance during treatment, patient should be instructed to discontinue treatment for several doses ; if dosing is interrupted for ≤3, restart treatment with same or lower dose; if dosing is interrupted for >3 days, restart treatment with 1.5 mg twice a day and titrate as described above

Interruption of treatment (Patch)

  • If dosing is interrupted for ≤3 days, restart treatment with same or lower strength patch; if dosing is interrupted for >3 days, restart treatment with 4.6 mg/24 hours patch and titrate as described above

Renal impairment

  • Oral: Patients with moderate and severe renal impairment may be able to only tolerate lower doses
  • Transdermal: Not studied; dosage adjustment may not be required

Hepatic impairment

  • Mild-to-moderate hepatic impairment (Child-Pugh class A and B): 1.5 mg qDay with slow titration recommended for oral administration; transdernal patch, not to exceed 4.6 mg q24hr
  • Severe hepatic impairment: Not studied

Low body weight (<50 kg)

  • Carefully titrate and monitor patients for toxicities (eg, excessive nausea, vomiting), and consider reducing maintenance dose if toxicities develop while taking orally; reduce to 4.6 mg q24hr if toxicities develop with transdermal patch

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
  • Apply patch on day following last oral dose

Not applicable

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Interactions

Interaction Checker

and rivastigmine

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (14)

              • atenolol

                atenolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • betaxolol

                betaxolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • bisoprolol

                bisoprolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • esmolol

                esmolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • levobunolol

                levobunolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • metoclopramide

                rivastigmine, metoclopramide. Either increases toxicity of the other by antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Avoid or Use Alternate Drug.

                metoclopramide, rivastigmine. Either increases toxicity of the other by antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Avoid or Use Alternate Drug.

              • metoprolol

                metoprolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • nadolol

                nadolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • nebivolol

                nebivolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • ponesimod

                ponesimod, rivastigmine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

              • propranolol

                propranolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • sotalol

                sotalol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • timolol

                timolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • triamcinolone acetonide injectable suspension

                triamcinolone acetonide injectable suspension, rivastigmine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 24 hours before initiating corticosteroid therapy.

              Monitor Closely (54)

              • aclidinium

                rivastigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • amifampridine

                amifampridine and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • amitriptyline

                rivastigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • aspirin

                rivastigmine increases toxicity of aspirin by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • atropine IV/IM

                rivastigmine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • bethanechol

                bethanechol and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

                rivastigmine and bethanechol both increase cholinergic effects/transmission. Use Caution/Monitor.

              • carbachol

                carbachol and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • celecoxib

                rivastigmine increases toxicity of celecoxib by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • cevimeline

                cevimeline and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

                rivastigmine and cevimeline both increase decreasing elimination. Use Caution/Monitor.

              • clomipramine

                rivastigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • darifenacin

                darifenacin decreases effects of rivastigmine by cholinergic effects/transmission. Use Caution/Monitor.

              • dichlorphenamide

                dichlorphenamide and rivastigmine both decrease serum potassium. Use Caution/Monitor.

              • diclofenac

                rivastigmine increases toxicity of diclofenac by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • diflunisal

                rivastigmine increases toxicity of diflunisal by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • donepezil

                donepezil and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • doxepin

                rivastigmine increases and doxepin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • echothiophate iodide

                echothiophate iodide and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • etodolac

                rivastigmine increases toxicity of etodolac by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • fenoprofen

                rivastigmine increases toxicity of fenoprofen by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • fesoterodine

                fesoterodine decreases effects of rivastigmine by cholinergic effects/transmission. Use Caution/Monitor.

              • flurbiprofen

                rivastigmine increases toxicity of flurbiprofen by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • galantamine

                galantamine and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • glycopyrrolate inhaled

                rivastigmine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • hyoscyamine spray

                rivastigmine increases and hyoscyamine spray decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • ibuprofen

                rivastigmine increases toxicity of ibuprofen by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • ibuprofen IV

                rivastigmine increases toxicity of ibuprofen IV by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • indomethacin

                rivastigmine increases toxicity of indomethacin by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • ketoprofen

                rivastigmine increases toxicity of ketoprofen by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • ketorolac

                rivastigmine increases toxicity of ketorolac by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • maprotiline

                rivastigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • meclofenamate

                rivastigmine increases toxicity of meclofenamate by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • mefenamic acid

                rivastigmine increases toxicity of mefenamic acid by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • meloxicam

                rivastigmine increases toxicity of meloxicam by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • nabumetone

                rivastigmine increases toxicity of nabumetone by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • naproxen

                rivastigmine increases toxicity of naproxen by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • neostigmine

                neostigmine and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • oxaprozin

                rivastigmine increases toxicity of oxaprozin by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • oxybutynin

                oxybutynin and rivastigmine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin transdermal

                rivastigmine increases and oxybutynin transdermal decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • physostigmine

                physostigmine and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • pilocarpine

                pilocarpine and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

                rivastigmine and pilocarpine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • pilocarpine ophthalmic

                pilocarpine ophthalmic and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • piroxicam

                rivastigmine increases toxicity of piroxicam by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • pralidoxime

                rivastigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • protriptyline

                rivastigmine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pyridostigmine

                pyridostigmine and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • salicylates (non-asa)

                rivastigmine increases toxicity of salicylates (non-asa) by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • salsalate

                rivastigmine increases toxicity of salsalate by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • solifenacin

                solifenacin decreases effects of rivastigmine by cholinergic effects/transmission. Use Caution/Monitor.

              • succinylcholine

                rivastigmine and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor. Potential for prolonged neuromuscular blockade. Rivastigmine may increase serum concentration of succinylcholine.

              • sulindac

                rivastigmine increases toxicity of sulindac by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • tolmetin

                rivastigmine increases toxicity of tolmetin by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.

              • tolterodine

                tolterodine and rivastigmine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trospium chloride

                trospium chloride decreases effects of rivastigmine by cholinergic effects/transmission. Use Caution/Monitor.

              Minor (6)

              • aspirin rectal

                rivastigmine increases toxicity of aspirin rectal by pharmacodynamic synergism. Minor/Significance Unknown. Increased GI symptoms.

              • aspirin/citric acid/sodium bicarbonate

                rivastigmine increases toxicity of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown. Increased GI symptoms.

              • choline magnesium trisalicylate

                rivastigmine increases toxicity of choline magnesium trisalicylate by pharmacodynamic synergism. Minor/Significance Unknown. Increased GI symptoms.

              • desipramine

                rivastigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

              • ketorolac intranasal

                rivastigmine increases toxicity of ketorolac intranasal by pharmacodynamic synergism. Minor/Significance Unknown. Increased GI symptoms.

              • trazodone

                rivastigmine increases and trazodone decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

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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%)

              Postmarketing Reports

              Cardiac Disorders: Tachycardia

              Hepatobiliary Disorders: Abnormal liver function tests, hepatitis

              Nervous System Disorders: Seizure

              Psychiatric Disorders: Aggression, nightmares

              Skin and Subcutaneous Tissue Disorders: Allergic dermatitis, application site hypersensitivity (patch), blister, disseminated allergic dermatitis, Stevens-Johnson syndrome, urticarial

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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

              There are no adequate data on developmental risks associated with use of drug in pregnant women

              Animal data

              • In animals, no adverse effects on embryo-fetal development were observed at oral doses 2-4 times maximum recommended human dose (MRHD)

              Lactation

              There are no data on presence of drug in human milk, effects on breastfed infant, or on milk production; the drug and its metabolites are excreted in rat milk following oral administration of rivastigmine; levels of rivastigmine plus metabolites in rat milk are approximately 2 times that in maternal plasma; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or underlying maternal condition

              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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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Exelon transdermal
              -
              4.6 mg/24 hour transdermal system
              Exelon transdermal
              -
              13.3 mg/24 hour transdermal system
              Exelon transdermal
              -
              9.5 mg/24 hour transdermal system
              Exelon transdermal
              -
              9.5 mg/24 hour transdermal system
              Exelon transdermal
              -
              4.6 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              13.3 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              9.5 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              9.5 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              4.6 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              9.5 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              4.6 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              13.3 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              13.3 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              4.6 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              13.3 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              13.3 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              9.5 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              4.6 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              9.5 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              4.6 mg/24 hour transdermal system
              rivastigmine transdermal
              -
              9.5 mg/24 hour transdermal system

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              rivastigmine transdermal

              RIVASTIGMINE PATCH - TRANSDERMAL

              (riv-uh-STIG-meen)

              COMMON BRAND NAME(S): Exelon

              USES: 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 TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start using this medication and each time you get a refill. Follow all instructions for how to properly apply and use the patches. If you have any questions, consult your doctor or pharmacist.Apply the patch to the skin as directed by your doctor, usually once daily. Do not open the sealed pouch until ready to use. Open the pouch and remove the patch from the protective liner. Do not cut the patch. Apply the patch as directed to a clean, dry, hairless area on the back, upper arm, or chest. Remove the old patch first before applying a new patch. Do not wear 2 patches at the same time. Do not apply the patch to red/irritated/broken areas of skin or to areas where you have applied creams or lotions. Avoid applying it to areas where tight clothing may rub the patch off. You can bathe with the patch on.When changing your patch, remove the old patch, fold it in half with the sticky sides together, and throw it away out of reach of children and pets. Apply a new patch to a different area to prevent skin irritation. Do not apply a new patch to the same area for at least 2 weeks.If the patch falls off before it is due to be changed, apply a new patch right away and replace the new patch at the regularly scheduled time the next day. Do not try to reapply the old patch or use tape to keep a loose patch from falling off.Do not touch your eyes while you are handling the patch. Wash your hands with soap and water after each application. If the medication comes in contact with your eyes or if your eyes become red after handling the patch, rinse your eyes right away with water. Tell your doctor if the redness or other symptoms do not go away.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 using a lower dose of the patch and may increase your dose after 4 weeks. Follow your doctor's instructions carefully. Do not increase your dose or use this drug more often than prescribed. Do not apply more than one patch per day or leave the patch on for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.Use this medication regularly to get the most benefit from it. To help you remember, change your patch at the same time each day.If you do not use 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.

              SIDE EFFECTS: Nausea, vomiting, loss of appetite/weight loss, diarrhea, weakness, dizziness, drowsiness, shakiness (tremors), and skin irritation at the application site may occur. 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.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using rivastigmine, tell your doctor or pharmacist if you are allergic to it (including any serious allergic skin reaction with past use of the patch); 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 problems (such as sick sinus syndrome, other conduction disorders), fainting, seizures, problems urinating (such as due to enlarged prostate), liver disease.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) 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 (cannabis).While wearing your patch, avoid exposing it to direct heat (such as prolonged direct sunlight, heating pads, electric blankets, heat lamps, saunas, hot tubs). Heat may cause more drug to be released into your body, increasing the chance of side effects.If you are going to have an MRI test, tell testing personnel that you are using this patch. Some patches may contain metals that can cause serious burns during an MRI. Ask your doctor whether you will need to remove your patch before the test and apply a new patch afterward, and how to do so properly.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.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.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 81-162 milligrams a day), should be continued. Consult your doctor or pharmacist for more details.

              OVERDOSE: This medication patch may be harmful if chewed or swallowed. If someone has overdosed, remove the patch if possible. For serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe or persistent nausea/vomiting, excessive sweating, very slow heartbeat, slow or shallow breathing, seizure.

              NOTES: Do not share this medication with others.Your doctor should check your weight periodically to monitor for side effects.

              MISSED DOSE: If you miss a dose, use it as soon as you remember. Replace the new patch at the regularly scheduled time the next day. Do not use 2 patches to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised March 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              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
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
              Additional Offers
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.