Rivastigmine belongs to a family of medications known as cholinesterase inhibitors. It is used to treat symptoms of mild to moderate Alzheimer's disease.

Alzheimer's disease is caused by the constant degeneration of certain nerve cells in the brain that make a chemical called acetylcholine. This chemical is thought to be important for the processes of learning and memory. Rivastigmine prevents the breakdown of acetylcholine, thereby increasing its levels in the brain. Rivastigmine provides the most benefit when there are enough cells producing adequate levels of acetylcholine (i.e., in mild to moderate disease) and provides little benefit when the disease becomes severe.

Rivastigmine may improve cognitive function (memory, orientation, and language) and general ability to perform activities of daily living. Rivastigmine may take up to 12 weeks to begin working, but individual response varies.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

The dose of rivastigmine can vary, but the recommended starting dose is 1.5 mg twice daily with food, increased gradually to the best tolerated dose. The highest dose recommended is 6 mg twice a day.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

Rivastigmine should be taken twice a day, once with breakfast and once with the evening meal. The capsules must be swallowed whole and should be taken on a regular basis every day in order to be effective.

The oral solution can be withdrawn from its container using the syringe provided. It can be swallowed directly from the syringe, or mixed with a small amount of water, cold fruit juice, or soda. If you mix it into a beverage, make sure to stir and drink the full amount.

This medication should be taken exactly as prescribed by your doctor. If you miss a dose of rivastigmine, skip the missed dose and continue regular dosing with the next scheduled dose. Do not double-up on doses.

Store rivastigmine away from direct sunlight and heat.

Exelon^® capsules are available in strengths of 1.5 mg, 3 mg, 4.5 mg, and 6 mg.

1.5 mg: Each yellow, hard gelatin capsule, with "1.5 mg" and "Exelon" printed in red on the body of the capsule, contains rivastigmine 1.5 mg.
3 mg: Each orange, hard gelatin capsule, with "3 mg" and "Exelon" printed in red on the body of the capsule, contains rivastigmine 3 mg.
4.5 mg: Each red, hard gelatin capsule, with "4.5 mg" and "Exelon" printed in white on the body of the capsule, contains rivastigmine 4.5 mg.
6 mg: Each orange-and-red, hard gelatin capsule,with "6 mg" and "Exelon" printed in red on the body of the capsule, contains rivastigmine 6 mg.
Nonmedicinal ingredients: hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, and silicon dioxide; hard gelatin capsules: gelatin, red iron oxide and/or yellow iron oxide and titanium dioxide.

This medication should not to be used by anyone who is allergic to rivastigmine or to any of the ingredients of the medication.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor. Your health professional may be able to help you deal with some of the effects.

The following side effects may go away as your body becomes used to the medication; check with your doctor if they continue or become bothersome.

More common:

• abdominal or stomach pain or cramping
• bloated, "full" feeling
• confusion
• constipation
• depression
• dizziness
• fatigue
• headache
• seeing, hearing, or feeling things that are not there
• trouble sleeping

  Less common:

• general feeling of discomfort or illness
• increased sweating
• runny nose

Check with your doctor as soon as possible if any of the following side effects occur:

More common:

• diarrhea
• indigestion
• loss of appetite
• loss of strength
• nausea and vomiting
• weight loss

  Less common:

• high blood pressure
• fainting

  Rare:

• aggression
• convulsions (seizures)
• trembling and shaking of hands and fingers
• trouble urinating

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Heart disease: People with certain types of heart disease (e.g., congestive heart failure, coronary artery disease) should use rivastigmine with caution.

Breathing conditions: People with a history of asthma or obstructive lung disease (e.g., emphysema, chronic bronchitis) should use rivastigmine with caution.

Liver and kidney function: People with reduced liver or kidney function who are taking this medication should be closely monitored by their doctors.

Stomach problems: The use of rivastigmine is associated with significant stomach side effects including nausea, vomiting, loss of appetite, and weight loss.

Pregnancy: Do not use this medication during pregnancy unless the expected benefits outweigh the potential risks.

Breast-feeding: It is not known whether rivastigimine passes into breast milk. Nursing mothers should not take this medication.

• anticholinergic medications (e.g., benztropine)
• bethanechol
• other cholinesterase inhibitors (e.g., donepezil)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.