Exelon Patch 10 (Rivastigmine) 9.5mg/24hr

Acetylcholinesterase Inhibitor

CSA NA – FDA Approved – REMS (N) – Can Ship

A deficiency in cortical acetylcholine is thought to be a cause of some of the symptoms of both Parkinson’s induced dementia and Alzheimer’s disease. Rivastigmine reversibly inhibits acetylcholinesterase thereby preventing the breakdown of acetylcholine via hydrolysis in the central nervous system.

Rivastigmine, Exelon is officially indicated for Alzheimer’s dementia and Parkinson disease dementia.  It is also prescribed off-label for vascular dementia and dementia with Lewy bodies.  (may be used for conditions not listed)

Before starting Rivastigmine, Exelon make sure your physician is aware of any allergies or medications you currently take, if you have peptic ulcer disease, respiratory disease, a seizure disorder, a urinary tract obstruction, or are pregnant or breastfeeding.   Let your physician know if you are a smoker as nicotine can increase metabolism of rivastigmine by 23%. Patients weighing less than 50kg or more than 100kg will have altered systemic absorption and dosage may be adjusted.

Oral: 1.5-6mg twice daily spaced approximately 12 hours apart

Patch: Apply one patch every 24 hours.  Dosage should be started at 4.6mg/24hour then slowly increased after 4 weeks to 9.5mg/24hour then after at least 4 weeks up to the maximum dosage of 13.3mg/24hour for more severe symptoms.  If the patch is stopped for up to three days, it may be continued at previous dose, however if it is stopped for over three days the dosage should be restarted at 4.6mg/24hour.

How to Take Rivastigmine, Exelon: Oral: Follow instructions provided by physician/pharmacy label, swallow whole with food, take consistently at same times each day unless otherwise directed, store at room temperature.  

Patch:   Follow instructions provided by physician/pharmacy label, apply patch to clean, hair-free area of skin, remove old patch before applying a new one, rotate application site.

You Need to Avoid: Do not apply patch to red or irritated skin, avoid exposing patch to external heat source for long periods of time, wash hands after handling patch (do not touch eyes)

>10%:

Central nervous system: Dizziness (oral: 6% to 21%; transdermal: ≤6%), headache (oral: 4% to 17%; transdermal ≤4%), agitation (transdermal: 1% to 14%), falling (6% to 12%)

Endocrine & metabolic: Weight loss (3% to 26%)

Gastrointestinal: Nausea (oral: 17% to 47%; transdermal: 2% to 10%), vomiting (oral: 13% to 31%; transdermal: 3% to 9%), diarrhea (oral: 5% to 19%; transdermal: ≤7%), anorexia (oral: ≤17%; transdermal: ≤3%), abdominal pain (oral: 13%; transdermal: 2%)

Local: Application site erythema (transdermal: 1% to 13%)

Neuromuscular & skeletal: Tremor (oral: 4% to 23%; transdermal: 7%)                                                                                        

1. What do I do if side effects are intolerable?
   If you are just starting this medication or just had a dosage increase, then it is common to have more prominent side effects for 2 weeks or so and if any remain at that point they will likely remain.  If the symptoms are causing a lot of distress speak to your physician as soon as possible to discuss how to come off the medication. 
2. No improvement has occurred since starting this medication, should I keep taking it?
   This medication does not improve memory or other symptoms of dementia, it only slows the progression of the condition, so it is important to be continued.  It is important to understand this distinction so expectations can be effectively managed.