Generic
Rivastigmine
23 brands available in the market
At a glance
Rivastigmine is used for symptomatic treatment of mild to moderate dementia in Alzheimer's disease and dementia associated with Parkinson's disease. It is a cholinesterase inhibitor that increases acetylcholine levels in the brain, improving memory, awareness, and daily functioning.
Description
Rivastigmine is a carbamate derivative structurally related to physostigmine. It reversibly inhibits acetylcholinesterase and butyrylcholinesterase in the brain, preventing the breakdown of acetylcholine and increasing its concentration at cholinergic synapses, thereby enhancing cholinergic neurotransmission.
Indications
- Mild to moderate dementia of Alzheimer's type
- Dementia associated with idiopathic Parkinson's disease
Therapeutic class
Drugs for Dementia
Pharmacological class
Cholinesterase Inhibitor
Pharmacology
Rivastigmine binds to and inactivates acetylcholinesterase and butyrylcholinesterase enzymes, preventing hydrolysis of acetylcholine. This leads to increased acetylcholine levels in the CNS, which improves cholinergic neurotransmission, memory, awareness, and ability to perform daily activities.
Mechanism of action
Reversibly inhibits cholinesterase enzymes, increasing acetylcholine levels in the brain.
Dosage
Capsule (Adult):
- Initial: 1.5 mg twice daily (with morning and evening meals)
- Titration: Increase to 3 mg twice daily after 2 weeks; then to 4.5 mg and 6 mg twice daily based on tolerability
- Maintenance: 3-6 mg twice daily (maximum 6 mg twice daily)
Transdermal Patch:
- Initial: 4.6 mg/24 hours
- Titration: Increase to 9.5 mg/24 hours after 4 weeks; then to 13.3 mg/24 hours after additional 4 weeks if needed
Administration
- Capsules: Take with meals (morning and evening)
- Patch: Apply a new patch every 24 hours on clean, dry, intact skin
- Do not chew, crush, or break capsules
Missed dose
If you miss a dose, skip it and continue with your regular schedule; do not double the dose.
Side effects
Common Side Effects:
- Nausea and vomiting (38% and 23%) – especially during dose titration
- Loss of appetite and weight loss
- Dizziness and headache
- Excessive sweating and weakness
- Abdominal pain and diarrhea
Precautions & warnings
- Caution in sick sinus syndrome or conduction defects
- Caution in asthma or obstructive pulmonary disease
- Caution in peptic ulcer and urinary obstruction
- Monitor body weight regularly
- Use in pregnancy only if clearly necessary
Contraindications
- Hypersensitivity to rivastigmine or other carbamate derivatives
- Severe hepatic impairment (Child-Pugh C)
Drug interactions
- May exaggerate effects of succinylcholine-type muscle relaxants during anesthesia
- May interfere with anticholinergic medications
- Avoid concomitant use with other cholinomimetic drugs
- Tobacco smoking may increase clearance
Food interactions
It is not known whether alcohol is safe with Rivastigmine; consult your doctor.
Use in pregnancy
Use in Pregnancy: Generally considered safe; animal studies show low or no adverse effects; limited human data; use if clearly needed.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Probably unsafe; limited data suggests drug may pass into breast milk and harm the baby; consult your doctor.
Pediatric use
Not recommended for children; safety and efficacy not established.
Geriatric use
Caution required in elderly patients; dose adjustment may be needed.
Renal / hepatic impairment
Renal Impairment: Safe in kidney disease; no dose adjustment needed; close monitoring advised; consult your doctor.
Hepatic Impairment: Safe in liver disease; no dose adjustment needed; close monitoring advised; avoid in severe hepatic impairment; consult your doctor.
Overdose effects
Overdose may cause nausea, vomiting, diarrhea, hypertension, or hallucinations; atropine may be used; if asymptomatic, skip next dose for 24 hours.
Storage conditions
Store in a cool and dry place, protected from light; keep out of reach of children.
Chemical structure
Rivastigmine