Rivastigmine

Sounds like 'ri-va-stig-meen'

Key points about rivastigmine

Rivastigmine is used to treat dementia associated with Alzheimer's disease.
Rivastigmine is also called Exelon®.
Find out how to take it safely and possible side effects.

Rivastigmine is in a class of medications called cholinesterase inhibitors. It's used to treat mild-to-moderate dementia due to Alzheimer's disease. Rivastigmine may also be used for people with mixed dementia, dementia in Parkinson's disease and dementia with Lewy bodies.

Rivastigmine helps to ease the symptoms of Alzheimer's disease, such as memory loss, but doesn't cure it. Rivastigmine works by increasing the amount of a chemical in the brain called acetylcholine, known to be lower in people living with dementia due to Alzheimer's disease. Read more about medicines for dementia.

In Aotearoa New Zealand rivastigmine is available as capsules and patches (which you apply on your skin). Only the patches are funded for Alzheimer's disease – the capsules are not funded.

Your doctor will start you on a low dose and, if needed, will increase your dose slowly after a few weeks. This allows your body to get used to the medicine and reduces the chances of side effects.
Always take your rivastigmine exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.

Skin patch

Apply 1 patch each day to the non-hairy skin on either your back, upper arm or chest.
Make sure the old patch is removed before you apply a new patch.
Apply the new patch on a different area and avoid using the same area for 14 days.
If the patches cause any irritation to your skin, let your doctor know about this. Read more about tips to apply medicine patches safely.
If you forget to replace your patch, do this as soon as you remember.
If your patch falls off, apply a new patch for the rest of the day. Replace this patch the next day at the same time as usual. Don't re-apply the used patch. Applying a new patch ensures that your body keeps getting the medicine it needs.

Capsules

Take rivastigmine capsules twice a day in the morning and evening.
Rivastigmine capsules are best taken with food – with your morning and evening meal.
Swallow the capsules whole – don't chew or crush them.
If you forget to take your dose, take it as soon as you remember. But if it's nearly time for your next dose, just take the next dose at the right time. Don't take double the dose.

Here are some things to know when you're taking rivastigmine. Other things may be important as well, so ask your healthcare provider what you should know about.

You may need regular tests

Before you start rivastigmine, you will have an ECG to check your heart. While you're taking rivastigmine you'll be monitored by your doctor regularly to check your heart rate, and to monitor for any side effects. Your doctor will check your response to treatment, if the dose is right, and if this medicine is right for you.

Taking other medicines and supplements

Rivastigmine can interact with some medicines, herbal supplements and rongoā Māori, so check with your doctor or pharmacist before starting rivastigmine and before starting any new products.

Rivastigmine may affect your ability to drive

Rivastigmine can impair your ability to do tasks such as driving or using machines. Alcohol makes this worse. Discuss your risk with your healthcare provider.

Tell your healthcare providers

Make sure you tell anyone providing you with health, dental or medical care that you are taking rivastigmine. This is particularly important if you're going to need a general anaesthetic.

Let your doctor know if you have ever had problems with your bladder, heart, stomach or if you have asthma, lung conditions or seizures.

Like all medicines, rivastigmine can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects	What should I do?
Nausea (feeling sick) or vomiting (being sick) or dyspepsia (reflux)	If you are taking rivastigmine capsules, try taking them with food or a snack. Tell your doctor if nausea bother you.
Skin rash near the patch (if you are using patches)	Let your doctor know.
Loss of appetite Headache Diarrhoea Increased salivation, sweating	These are quite common when you first start taking rivastigmine and usually go away with time. Your doctor may check your weight at your regular visits. Tell your doctor if they bother you.
Tiredness Feeling sleepy Dizziness, Feeling faint Headache	Try getting up or moving slowly. If you begin to feel faint, sit or lie down until the feeling passes, to avoid falls. Avoid driving until you know how this medicine affects you. Don't drink alcohol. Tell your doctor if this continues.
Anxiety Tremor Confusion Having trouble sleeping	Let your doctor know.
Signs of stomach problems such as severe tummy pain, blood in your stool or black stools, vomiting blood or dark-coloured vomit	Tell your doctor immediately or phone Healthline 0800 611 116.