Rivastigmine

Sounds like 'ri-va-stig-meen'

Easy-to-read medicine information about rivastigmine – what it is, how to take it safely and possible side effects.

 Type of medicine Also called
  • Medicine for dementia
  • Belongs to a group of medicines known as cholinesterase inhibitors
  • Exelon®
  • Rimane®

What is rivastigmine?

Rivastigmine is in a class of medications called cholinesterase inhibitors. It is used to treat dementia associated with Alzheimer's disease. Rivastigmine helps to ease the symptoms of Alzheimer's disease, such as memory loss, but does not cure it. Rivastigmine works by increasing the amount of a chemical in the brain called acetylcholine, which is known to be lower in people suffering from dementia in Alzheimer's disease. Read more about medicines for dementia

In New Zealand rivastigmine is available as capsules and a patch you apply on the skin.

Dose

  • Your doctor will start you on a low dose of the capsules or patch 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 rivastigmine to take, how often to take it and any special instructions.
  • You will need to see your doctor regularly to check your response to treatment, if the dose is right, and if this medicine is right for you. 

How to take rivastigmine

  • Capsules: take rivastigmine capsules twice a day in the morning and evening. Rivastigmine capsules are best taken with food. Swallow the capsules whole – do not chew or crush them.
  • Skin patch: apply one 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.
  • If you forget to take your dose, take it as soon as you remember. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.
  • If you forget to replace your patch, do this as soon as you remember. 
  • If you forget to take rivastigmine capsules for more than 3 days, or if you forget to apply the patch for more than 3 days, talk with your doctor before starting it again. You may need to re-start rivastigmine on a lower dose.
  • There are several different strengths of rivastigmine capsules and patches available, so make sure you have been given is the strength you were expecting. If you are unsure, ask your pharmacist for advice. Your dose may change over time.

Precautions – before starting rivastigmine

  • Do you have problems with your kidneys or liver?
  • Do you have any heart problems?
  • Do you have problems with your breathing such as asthma or COPD?
  • Do you have problems passing urine (peeing)?
  • Do you have epilepsy?
  • Have ever had a stomach (gastric) or duodenal ulcer?
  • Are you taking any other medicines, including medicines you can buy without a prescription, such as herbal and complementary medicines or pain relief medicines?

If so, it’s important that you tell your doctor or pharmacist before you start rivastigmine. Sometimes a medicine isn’t suitable for a person with certain conditions or it can only be used with extra care.

Possible side effects

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)
  • Try taking rivastigmine with food or a snack.
  • Tell your doctor if troublesome.
  • Loss of appetite
  • Headache
  • Diarrhoea
  • Increased salivation, sweating
  • These are quite common when you first start taking rivastigmine and usually goes away with time.
  • Tell your doctor if troublesome. 
  • Tiredness
  • Feeling sleepy
  • Dizziness,
  • Feeling faint
  • Try getting up or moving slowly.
  • If you begin to feel faint, sit or lie down until the feeling passes.
  • Avoid driving until you know how this medicine affects you.
  • Do not drink alcohol.
  • Tell your doctor if this continues.
  • 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.

Learn more

Exelon Medsafe consumer information sheets
Rivastigmine New Zealand Formulary patient information

References

  1. The pharmacological management of Alzheimer’s disease – the place of donepezil BPAC, NZ, 2010
  2. Antipsychotics in dementia – best practice guide BPAC, NZ
  3. Managing patients with dementia – what is the role of antipsychotics? BPAC, NZ, 2013
  4. Rivastigmine New Zealand Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 27 Mar 2019