Pharm

Rivastigmine

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Rivastigmine, Exelon

  • Mechanism
  1. See Acetylcholinesterase Inhibitor
  2. Carbamate-based noncompetitive Cholinesterase Inhibitor
  3. Inhibits butyrylcholinesterase and acetylcholinesterase
  4. Increases Cholinergic transmission
  • Pharmacokinetics
  • Oral Route
  1. Peak: 1 hour
  2. Duration: 10 hours
  • Drug Interactions
  1. No significant Drug Interactions
  • Efficacy
  1. Modestly improves scores on Neuropsychological Tests
  2. Benefits decrease after 40 weeks of treatment
  • 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
  • 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