Rivastigmine helps ease the symptoms of memory loss and dementia.
You will be given a small dose when you first start treatment. This will gradually be increased.
If you are taking the capsules or liquid medicine, take your doses after a meal.
If you are using the patches, make sure you remove the old patch before applying a new one.
|Type of medicine||Anti-dementia medicine (an acetylcholinesterase inhibitor)|
|Used for||Dementia associated with Alzheimer's disease or Parkinson's disease|
|Also called||Almuriva®; Alzest®; Exelon®; Nimvastid®; Voleze®|
|Available as||Capsules, oral liquid medicine and skin patches|
Rivastigmine cannot cure dementia, but it can slow down the progression of the symptoms in some people. It works by increasing the level of a natural chemical called acetylcholine. This is a chemical which allows nerve cells in the brain to communicate with each other, and it is known that people with dementia have low levels of it. The symptoms of dementia can be improved by increasing the levels of acetylcholine.
Rivastigmine will be prescribed by a specialist doctor. If you are a caregiver, please read this leaflet on behalf of the person who is receiving rivastigmine.
Before taking rivastigmine
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking rivastigmine it is important that your doctor or pharmacist knows:
- If you have liver or kidney problems.
- If you have a heart condition.
- If you have any problems with your breathing, such as asthma or chronic obstructive pulmonary disease (COPD).
- If you have any problems passing urine.
- If you have ever had a stomach (gastric) or duodenal ulcer.
- If you have ever had fits (convulsions or seizures).
- If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
- If you have ever had an allergic reaction to a medicine.
How to take rivastigmine
- Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about rivastigmine and a full list of side-effects which you may experience from it.
- Your caregiver will help you take your medicine exactly as your doctor has told you. It is usual to be prescribed two doses to take each day. Your dose will be written on the label of your pack to remind you.
- There are several different strengths of rivastigmine capsules and patches available, so make sure the product you have been given is the strength you were expecting. If you are unsure, ask your pharmacist for advice.
- Ideally the capsules or liquid medicine should be taken with, or soon after, your breakfast and your evening meal. Try to take your doses at the same times each day as this will help you to remember to take them.
- If you have been prescribed capsules to take, you should swallow the capsule whole without chewing or crushing it. Taking your doses with a small drink of water may help.
- If you forget to take a dose, take it as soon as you remember, unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a forgotten dose.
- If you forget to take rivastigmine for several days, talk with your doctor before starting to take it again, as you may need to re-start your treatment on a lower dose.
- If you have been prescribed skin patches, you will be asked to apply one patch each day. Make sure the previous day's patch is removed before you apply a new patch. If the patches cause any irritation to your skin, you should let your doctor know about this.
Taking rivastigmine oral liquid medicine
- Read the manufacturer's instructions for the medicine you have been given.
- Open the bottle and remove the oral dosing syringe and bottle adaptor provided.
- Push the nozzle of the syringe into the bottle adaptor and insert it firmly into the top of the bottle.
- Turn the bottle upside down.
- Pull the plunger on the syringe a little way and push back up to get rid of any air bubbles. Then pull the plunger down to withdraw the required amount of medicine. Re-check your dose once you have removed the syringe from the bottle.
- You can swallow the medicine straight from the syringe, or you can stir it into a glass of water to drink it.
- When you have finished taking your dose, wipe the outside of the syringe with a tissue. The syringe can be cleaned in warm, soapy water.
Applying rivastigmine (Exelon®) patches
- Open a packet and remove the patch from inside.
- Apply the patch to an area of non-hairy skin on your back, upper arm, or chest (but not to your breast area). Press down on the patch with the palm of your hand for around 30 seconds. This will make sure it sticks firmly in place.
- After 24 hours, remove the patch and do not use the same area of skin to apply another patch to for at least 14 days.
- Repeat this process each day, removing the previous day's patch before applying a new patch.
- If you forget to apply a new patch for more than three days, talk with your doctor before applying another patch, as you may need a lower dose.
Getting the most from your treatment
- When starting your treatment your doctor will give you a small dose and then gradually increase the dose. This allows your doctor to make sure that you have the dose that helps your condition and avoids any unwanted side-effects.
- Your doctor will want to check your progress every few weeks to make sure the dose is right for you and that you are getting benefit from this treatment. Try to keep these regular doctor's appointments.
- If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking rivastigmine. This is because rivastigmine may affect the amount of any anaesthetic you may need.
- If you buy any medicines, always check with a pharmacist that they are safe to take with your other medicines. Some medicines can interfere with the way rivastigmine works.
Can rivastigmine cause problems?
Along with their useful effects, all medicines can cause unwanted side-effects although not everyone experiences them. The table below lists some of the most common ones associated with rivastigmine. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve over the first few days of taking a new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.
|Common rivastigmine side-effects||What can I do if I experience this?|
|Feeling sick (nausea) or being sick (vomiting), indigestion, tummy (abdominal) pain||Let your doctor know if this happens, as your treatment may need reviewing|
|Diarrhoea||Drink plenty of water to replace any lost fluids. Let your doctor know if it continues|
|Feeling dizzy or tired||Be especially careful if you are using any tools or machines|
|Headache||Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headaches continue, speak with your doctor|
|Loss of appetite, losing weight, feeling anxious or agitated, trembling, falling, sweating, and skin reactions (with the patches)||If any of these become troublesome, speak with your doctor|
If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.
How to store rivastigmine
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
- Once opened, a bottle of the medicine only keeps for one month. Do not store it or use it after this time.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Further reading and references
Manufacturer's PIL, Exelon® 4.6 mg/24h, 9.5 mg/24h, 13.3 mg/24h Transdermal Patch; Novartis Pharmaceuticals UK Ltd, The electronic Medicines Compendium. Dated April 2018.
Manufacturer's PIL, Rivastigmine Mylan 1.5 mg, 3 mg, 4.5 mg, 6 mg Hard Capsules; Mylan, The electronic Medicines Compendium. Dated September 2016.
Manufacturer's PIL, Rivastigmine Rosemont 2 mg/ml Oral Solution; Rosemont Pharmaceuticals Ltd, The electronic Medicines Compendium. Dated September 2019.
British National Formulary, 78th Edition (Sep 2019); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.