Rivatig 1.5

Indications

Rivastigmine is used to treat the symptoms of mild to moderate dementia in Alzheimer's disease and dementia linked to Parkinson's disease. It can help with memory, thinking and daily activities for a time, but it does not cure the disease or stop it from progressing.

How It Works

In dementia the brain has less acetylcholine, a chemical messenger that nerve cells use for memory and learning. Rivastigmine blocks the enzymes (cholinesterases) that break acetylcholine down, so more of it stays available in the brain.

Dosage and Administration

• Capsules or oral solution, adults: usually started at 1.5 mg twice a day with breakfast and dinner. The doctor raises the dose slowly, not more often than every 2 weeks, up to a usual maximum of 6 mg twice a day.
• Skin patch: as prescribed. Usually one patch a day on clean, dry, hairless skin of the upper back, upper arm or chest, using a different spot each day. Remove the old patch before putting on a new one.
• Always take capsules with food to reduce stomach upset.
• If doses are missed for more than 3 days, do not restart at the same dose; ask the doctor, who will usually restart at the lowest dose.

Interactions

Tell the doctor about all medicines, especially: Metoclopramide (can worsen tremor and stiffness); beta blockers such as Atenolol or Propranolol and other medicines that slow the heart (risk of a very slow pulse or fainting); medicines with anticholinergic effects, such as some bladder, allergy and older antidepressant medicines, which work against Rivastigmine; and muscle relaxants used during anaesthesia, so tell the surgical team before any operation.

Contraindications

• Allergy to Rivastigmine, similar medicines (carbamates) or any ingredient.
• A previous severe skin reaction to a Rivastigmine patch that spread beyond the patch area.

Side Effects

Common: nausea, vomiting, diarrhoea, loss of appetite, weight loss, dizziness, headache, tiredness and worsening tremor in people with Parkinson's disease. Patches can cause redness or itching where they are applied. Stomach side effects are most common when starting or increasing the dose.

Get urgent medical help for: a very slow or irregular heartbeat, fainting, severe or persistent vomiting or diarrhoea with signs of dehydration, vomiting blood or passing black stools, fits (seizures), or a spreading skin rash, swelling or breathing difficulty.

Pregnancy and Lactation

There is little information on use in pregnancy; it should be used only if the doctor decides it is clearly needed. Breastfeeding is not recommended during treatment.

Precautions and Warnings

• Tell the doctor about heart rhythm problems, stomach or duodenal ulcers, asthma or other lung disease, difficulty passing urine, seizures, or liver or kidney disease.
• People with low body weight may get more side effects; weight should be checked regularly.
• Use only one patch at a time and never cut it. Using extra patches by mistake can cause overdose.
• May cause dizziness or drowsiness; take care with driving or using machines.

Overdose

Too much can cause severe nausea, vomiting, diarrhoea, sweating, a slow heartbeat, low blood pressure, muscle weakness and breathing problems. Remove any patches and seek emergency medical help at once.

Therapeutic Class

Cholinesterase inhibitor (medicine for dementia).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Keep patches in their sealed sachet until use and fold used patches in half before throwing them away.