Rivastigmine

FDA label

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Titration Alzheimer's: increase at intervals of at least 2 weeks; Parkinson's disease dementia: increase at intervals of at least 4 weeks

Renal Moderate to severe impairment: may tolerate only lower doses

Hepatic Mild or moderate impairment: may tolerate only lower doses; no data in severe impairment

Instructions

• Take with meals in divided doses (morning and evening)
• If dosing is interrupted for more than 3 days, restart at 1.5 mg BID and re-titrate
• Low body weight (<50 kg): titrate and monitor carefully; consider dose reduction

Contraindications

• History of application-site reaction with rivastigmine transdermal patch suggestive of allergic contact dermatitis, absent negative allergy testing

Cautions

• GI adverse reactions (nausea, vomiting, diarrhea, anorexia, weight loss); dehydration can be serious
• Disseminated allergic dermatitis - discontinue if it occurs
• May exacerbate/induce extrapyramidal symptoms; worsening Parkinson tremor
• Seizures
• Peptic ulcers/GI bleeding (increased gastric acid secretion)
• Exaggerates succinylcholine-type muscle relaxation during anesthesia
• Vagotonic effects on heart rate (bradycardia); caution in sick sinus syndrome/conduction conditions
• Urinary obstruction; caution in asthma/obstructive pulmonary disease

Adverse reactions

• Nausea
• Vomiting
• Anorexia
• Dyspepsia
• Asthenia
• Diarrhea
• Dizziness
• Tremor
• Weight loss

Pregnancy No adequate human data; no adverse embryo-fetal effects in animals at 2-4x MRHD.

Lactation No human data; excreted in rat milk (~2x maternal plasma).