Rivastigmine

Aka: Rivastigmine, Exelon

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II. Indications

  1. Alzheimer Disease
  2. Lewy Body Dementia

III. Mechanism

  1. See Acetylcholinesterase Inhibitor
  2. Carbamate-based noncompetitive Cholinesterase Inhibitor
  3. Inhibits butyrylcholinesterase and Acetylcholinesterase
  4. Increases Cholinergic transmission

IV. Dosing

  1. Oral Route
    1. Initial: 1.5 mg orally twice daily with food for at least 2 weeks (4 weeks for Lewy Body Dementia)
    2. Next: 3 mg orally twice daily with food for at least 2 weeks (4 weeks for Lewy Body Dementia)
    3. Next: 4.5 mg orally twice daily with food for at least 2 weeks (4 weeks for Lewy Body Dementia)
    4. Next: 6 mg orally twice daily with food
  2. Transdermal Patch
    1. Initial: 4.6 mg patch every 24 hours for at least 4 weeks
    2. Next: 9.5 mg patch every 24 hours for at least 4 weeks
    3. Next: 13.3 mg patch every 24 hours
    4. Change patch application locations to prevent skin irritation

V. Adverse Effects

  1. See Acetylcholinesterase Inhibitor
  2. Specific adverse effects reported for Rivastigmine, not seen with other Acetylcholinesterase Inhibitors
    1. Abdominal Pain
    2. Atrial Fibrillation
    3. Myocardial Infarction
    4. Contact Dermatitis (allergic or irritant)
  3. Cardiovascular
    1. Syncope
    2. Atrioventricular Block
    3. Bradycardia
  4. Gastrointestinal
    1. Diarrhea
    2. Nausea or Vomiting
    3. Decreased appetite and Weight loss
  5. Neuropsychiatric
    1. Headache
    2. Myalgias
    3. Tremors
    4. Insomnia
    5. Dizziness and Fall Risk
    6. Vivid dreams

VI. Pharmacokinetics: Oral Route

  1. Peak: 1 hour
  2. Duration: 10 hours

VII. Drug Interactions

  1. No significant Drug Interactions

VIII. Efficacy

  1. Modestly improves scores on Neuropsychological Tests
  2. Benefits decrease after 40 weeks of treatment

IX. Resources

  1. Rivastigmine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=4ab335d1-19ee-4cd9-9776-8086645d19e4

X. References

  1. (2000) Med Lett Drugs Ther 42(1089):93-4 [PubMed]
  2. Corey-Bloom (1998) Int J Geriatr Psychopharm 1:55 [PubMed]
  3. Epperly (2017) Am Fam Physician 95(12): 771-8 [PubMed]
  4. Rosler (1999) BMJ 318:633 [PubMed]

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Related Studies

Cost: Medications

rivastigmine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
RIVASTIGMINE 1.5 MG CAPSULE Generic $0.21 each
RIVASTIGMINE 13.3 MG/24HR PTCH Generic $2.65 each
RIVASTIGMINE 3 MG CAPSULE Generic $0.26 each
RIVASTIGMINE 4.5 MG CAPSULE Generic $0.23 each
RIVASTIGMINE 4.6 MG/24HR PATCH Generic $2.44 each
RIVASTIGMINE 6 MG CAPSULE Generic $0.25 each
RIVASTIGMINE 9.5 MG/24HR PATCH Generic $2.21 each
exelon (on 1/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
EXELON 4.6 MG/24HR PATCH Generic $2.44 each
EXELON 9.5 MG/24HR PATCH Generic $2.21 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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