• Rivastigmine

    (ri va stig' meen)

    WHY is this medicine prescribed?

    Rivastigmine is used to treat dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and may cause changes in mood and personality) in people with Alzheimer's disease (a brain disease that slowly destroys the memory and ability to think, learn, communicate and handle daily activities). Rivastigmine is also used to treat dementia in people with Parkinson's disease (a brain and nervous system disease with symptoms of slowing of movement, muscle weakness, shuffling walk, and loss of memory). Rivastigmine is in a class of medications called cholinesterase inhibitors. It improves mental function (such as memory and thinking) by increasing the amount of a certain natural substance in the brain.

    HOW should this medicine be used?

    Rivastigmine comes as a capsule and solution (liquid) to take by mouth. It is usually taken twice a day with meals in the morning and evening. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take rivastigmine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    Your doctor will start you on a low dose of rivastigmine and slowly increase your dose, not more than once every 2 weeks.
    Rivastigmine may improve the ability to think and remember or slow the loss of these abilities, but does not cure Alzheimer's disease or dementia in people with Parkinson's disease. Continue to take rivastigmine even if you feel well. Do not stop taking rivastigmine without talking to your doctor.
    If you are taking rivastigmine oral solution, ask your pharmacist or doctor for a copy of the manufacturer's instructions for use. Carefully read these instructions. Always use the oral dosing syringe that comes with rivastigmine solution to measure your dose. Talk to your doctor or pharmacist if you have questions about how to measure your dose of rivastigmine solution.
    Rivastigmine oral solution may be swallowed directly from the syringe or mixed with a liquid before use. Mix it with a small glass of water, cold fruit juice, or soda. Be sure to stir the mixture completely. Do not mix this medication with any liquid other than the ones listed. If the medication is mixed with water, juice, or soda, it must be taken within 4 hours.
    To take a dose of rivastigmine solution, follow these steps:
    1. Remove the oral dosing syringe that came with this medication from its protective case.
    2. Push down and twist off the child-resistant cap to open the bottle of rivastigmine solution.
    3. Put the tip of the oral syringe into the white stopper opening on top of the bottle.
    4. While holding the syringe straight up, pull up on the plunger to the mark on the syringe that equals your dose.
    5. Check the liquid in the syringe for air bubbles. If there are large air bubbles, gently move the syringe plunger up and down a few times. Do not worry about a few tiny air bubbles.
    6. Make sure the plunger is on the mark on the syringe that equals your dose.
    7. Remove the oral syringe from the bottle by pulling up on it.
    8. Swallow your dose from the syringe directly, or mix it with the liquid you have chosen. Drink or swallow all of the solution.
    9. Wipe off the outside of the oral syringe with a clean tissue, and put the syringe back into its case.
    10. Close the child-resistant cap on the bottle of medication.

    Are there OTHER USES for this medicine?

    Rivastigmine is also used sometimes to treat Lewy body dementia (a condition in which the brain develops abnormal protein structures, and the brain and nervous system are destroyed over time). Talk to your doctor about the possible risks of using this medication for your condition.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking rivastigmine,
    • tell your doctor and pharmacist if you are allergic to rivastigmine, neostigmine (Prostigmin), physostigmine (Antilirium, Isopto Eserine), pyridostigmine (Mestinon, Regonol), any other medications, or any of the ingredients in rivastigmine solution. Ask your pharmacist for a list of the ingredients.
    • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antihistamines; aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); bethanechol (Duvoid, Urabeth, Urecholine); ipratropium (Atrovent); and medications for Alzheimer's disease, glaucoma, irritable bowel disease, motion sickness, myasthenia gravis, Parkinson's disease, ulcers, or urinary problems. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor if you have or have ever had asthma, an enlarged prostate or other condition that blocks the flow of urine, ulcers, abnormal heart beats, or other heartor lung disease.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking rivastigmine, call your doctor.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking rivastigmine.

    What SPECIAL DIETARY instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
    If you miss taking rivastigmine for more than a few days, talk to your doctor before starting to take it again. You will probably have to restart taking it at a lower dose.

    What SIDE EFFECTS can this medicine cause?

    Rivastigmine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • nausea
    • vomiting
    • loss of appetite
    • heartburn or indigestion
    • stomach pain
    • weight loss
    • diarrhea
    • constipation
    • gas
    • weakness
    • dizziness
    • headache
    • extreme tiredness
    • lack of energy
    • tremor or worsening of tremor
    • increased sweating
    • difficulty falling asleep or staying asleep
    • confusion
    Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
    • fainting
    • black and tarry stools
    • red blood in stools
    • bloody vomit
    • vomiting material that looks like coffee grounds
    • difficulty urinating
    • painful urination
    • seizures
    • depression
    • anxiety
    • aggressive behavior
    • hearing voices or seeing things that do not exist)
    • uncontrollable movements and muscle contractions
    Rivastigmine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children.Store it at room temperature and away from excess heat and moisture (not in the bathroom). Store rivastigmine solution in an upright position. Do not place rivastigmine solution in the freezer or allow rivastigmine solution to freeze.Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
    Symptoms of overdose may include:
    • nausea
    • vomiting
    • increased saliva
    • sweating
    • slow heart beat
    • inability to hold urine
    • slowed thinking and movement
    • dizziness
    • fainting
    • blurred vision
    • difficulty breathing
    • loss of consciousness
    • seizure

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor.
    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Exelon®

    Rivastigmine Transdermal

    (ri va stig' meen)

    WHY is this medicine prescribed?

    Rivastigmine transdermal patches are used to treat dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and may cause changes in mood and personality) in people with Alzheimer's disease (a brain disease that slowly destroys the memory and the ability to think, learn, communicate and handle daily activities). Transdermal rivastigmine is also used to treat dementia in people with Parkinson's disease (a brain system disease with symptoms of slowing of movement, muscle weakness, shuffling walk, and loss of memory). Rivastigmine is in a class of medications called cholinesterase inhibitors. It improves mental function (such as memory and thinking) by increasing the amount of a certain natural substance in the brain.

    HOW should this medicine be used?

    Transdermal rivastigmine comes as a patch you apply to the skin. It is usually applied once a day. Apply the rivastigmine patch at around the same time each day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use the rivastigmine skin patch exactly as directed. Do not apply it more or less often than prescribed by your doctor.
    Your doctor will probably start you on a low dose of rivastigmine and gradually increase your dose, not more often than once every 4 weeks.
    Transdermal rivastigmine may improve the ability to think and remember or slow the loss of these abilities, but it does not cure Alzheimer's disease or dementia in people with Parkinson's disease. Continue to use transdermal rivastigmine even if you feel well. Do not skip using transdermal rivastigmine without talking to your doctor.
    Apply the patch to clean, dry skin that is relatively free of hair (upper or lower back or upper arm or chest). Do not apply the patch to an open wound or cut, to skin that is irritated, red, or to skin that is affected by a rash or other skin problem. Do not apply the patch to a place that would be rubbed against by tight clothing. Select a different area each day to avoid skin irritation. Be sure to remove the patch before you apply another one. Do not apply a patch to the same spot for at least 14 days.
    If the patch loosens or falls off, replace it with a new patch. However, you should remove the new patch at the time that you were scheduled to remove the original patch.
    While you are wearing a rivastigmine patch, protect the patch from direct heat such as heating pads, electric blankets, heat lamps, saunas, hot tubs, and heated water beds. Do not expose the patch to direct sunlight for very long.
    To apply the patch, follow these steps:
    1. Choose the area where you will apply the patch. Wash the area with soap and warm water. Rinse off all of the soap and dry the area with a clean towel. Be sure the skin is free of powders, oil, and lotions.
    2. Select a patch in a sealed pouch and cut open the pouch open with scissors. Be careful not to cut the patch.
    3. Remove the patch from the pouch and hold it with the protective liner facing you.
    4. Peel the liner off one side of the patch. Be careful not to touch the sticky side with your fingers. A second strip of liner should remain stuck to the patch.
    5. Press the patch firmly onto your skin with the sticky side down.
    6. Remove the second strip of protective liner and press the rest of the sticky side of the patch firmly against your skin. Be sure that the patch is pressed flat against the skin with no bumps or folds and the edges are firmly attached to the skin.
    7. Wash your hands with soap and water after you handle the patch.
    8. After you have worn the patch for 24 hours, use your fingers to peel the patch off slowly and gently. Fold the patch in half with the sticky sides together and throw it away in a trash can that is out of reach of children and pets.
    9. Apply a new patch to a different area immediately by following steps 1 to 8.

    Are there OTHER USES for this medicine?

    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before using transdermal rivastigmine,
    • tell your doctor and pharmacist if you are allergic to rivastigmine, neostigmine (Prostigmin), physostigmine (Antilirium, Isopto Eserine), pyridostigmine (Mestinon, Regonol), or any other medications.
    • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antihistamines; bethanechol (Duvoid, Urecholine); ipratropium (Atrovent); and medications for Alzheimer's disease, glaucoma, irritable bowel disease, motion sickness, myasthenia gravis, Parkinson's disease, ulcers, or urinary problems.
    • tell your doctor if you have or have ever had asthma, an enlarged prostate or other condition that blocks the flow of urine, ulcers, abnormal heart beats, seizures, uncontrollable shaking of a part of the body, other heart or lung disease, or kidney or liver disease.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using transdermal rivastigmine, call your doctor.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are using transdermal rivastigmine.

    What SPECIAL DIETARY instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

    What should I do IF I FORGET to take a dose?

    Apply the missed patch as soon as you remember it. However, you should still remove the patch at your regular patch removal time. If it is almost time for the next patch, skip the missed patch and continue your regular dosing schedule. Do not apply extra patches to make up for a missed dose.

    What SIDE EFFECTS can this medicine cause?

    Transdermal rivastigmine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • nausea
    • vomiting
    • diarrhea
    • loss of appetite
    • stomach pain
    • weight loss
    • depression
    • headache
    • anxiety
    • dizziness
    • weakness
    • excessive tiredness
    • difficulty falling asleep or staying asleep.
    • tremor or worsening tremor
    Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
    • black and tarry stools
    • red blood in stools
    • bloody vomit
    • vomiting material that looks like coffee grounds
    • difficulty urinating
    • painful urination
    • seizures

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any patches that are outdated or no longer needed by opening each pouch, folding each patch in half with the sticky sides together. Place the folded patch in the original pouch and put in a closed trash can that is out of the reach of children and pets. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    If someone applies extra or a higher dosage of rivastigmine patches but does not have any of the symptoms listed below, remove the patch or patches. Call your doctor and do not apply any additional patches for the next 24 hours.
    Symptoms of overdose may include:
    • nausea
    • vomiting
    • diarrhea
    • increased saliva
    • sweating
    • slow heartbeat
    • dizziness
    • muscle weakness
    • difficulty breathing
    • fainting
    • seizures

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Exelon® Patch
  • Join WellZones today.

    Make a Change For LifeLearn more

    Wellmont LiveWell is creating a new tradition of wellness in the mountains by providing individuals with tools and encouragement to live healthier lifestyles.

  • HeartSHAPE Spotlight

    HeartSHAPE® Test Learn more

    Fight heart disease early and prevent heart attacks with HeartSHAPE® - a painless, non-invasive test that takes pictures of your heart to scan for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.


  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.