Rivastigmine (Exelon)
Acetylcholinesterase inhibitor
- Alzheimer’s and Parkinson’s Dementia1 (mild, moderate, severe).
- Ineffective: General cognition
Features
Dosing
Instant release: Start 1.5 mg bid, raise every 4 wk to 3-6 mg bid, max benefit at 6 mg bid.
Skin patch: Start 4.6 mg/24 hour, raise every 4 weeks to target 9.5-13.3 mg/24 hours.
Oral solution: 2 mg/ml.
INTERACTIONS: anticholinergic medications (eg, antipsychotics) may block effects. Beta-blockers increase risk of hypotension/falls. No CYP interactions.
Management
Second line for dementia, after donepezil. Use as skin patch if GI side effects.
Does not improve cognition in other conditions.
TOLERABILITY: Nausea, vomiting, low appetite, stomach pain, and weakness.
RISKS: Hypotension, syncope.
EMR Text
Dementia
Rivastigmine use based on FDA approval in dementia where it slowed progression of the illness and improved behavioral symptoms (Lockhart IA et al, Dement Geriatr Cogn Dis Extra 2011;1(1):212–227).
Rivastigmine side effects reviewed with patient.