Adult Dosing
Alzheimer’s type dementia (mild-moderate), Parkinson’s disease dementia (mild-moderate)
- Start with 4.6 mg/24 hrs patch qd for minimum 4 wks; if well tolerated, may increase dose to 9.5 mg/24 hrs qd
- Max: 13.3 mg/24 hrs
Switching from rivastigmine oral to rivastigmine TDP
- Patients on <6 mg/day PO can be switched to 4.6 mg/24 hrs patch
- Patients on 6-12 mg/day PO can be switched to 9.5 mg/24 hrs patch
Alzheimer’s type dementia (severe)
- Recommended dose: 13.3 mg/24 hrs patch qd; Max: 13.3 mg/24 hrs
Notes:- Apply only one patch at a time and replace the patch every 24 hrs
- Patch should be applied once a day to clean, dry, hairless area and application sites should be rotated; do not apply a new patch to the same site for at least 14 days
- Avoid application on red, irritated, cut or cracked skin
- Patch should not be cut and should not be exposed to heat sources for a long time
- While switching from oral therapy, apply the first patch on the day following the last oral dose
- If adverse effects cause intolerance during treatment, discontinue treatment for 3 or more days and restart at the same or next lower dose. If treatment is discontinued for >3 days, reinitiate treatment with the lowest daily dose and titrate as mentioned above
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
See Supplemental Patient Information
- Medication errors like use of multiple patches at one time or failure to remove old patch before applying a new one may result in serious adverse effects, rarely leading to death. Patients and caregivers should be given detailed instructions on appropriate use of patches
- Use of rivastigmine at higher than recommended doses may result in significant GI symptoms such as nausea, vomiting, diarrhea, anorexia, reduced appetite and weight loss; hence, start therapy with the lowest dose and gradually titrate to a higher maintenance dose
- If therapy is interrupted for >3 days, restart treatment with lowest dose to reduce the risk of severe vomiting and its serious sequelae
- Caregivers should be aware of the possible GI symptoms at higher than recommended doses and should inform the physician if they occur
- Caregivers should be informed that if therapy has been interrupted for more than 3 days, the next dose should be withheld until it has been discussed with the physician
- Application site skin reactions of mild or moderate intensity may occur with use of rivastigmine patch
- Allergic contact dermatitis should be suspected if application site skin reactions diffuse outside the area of patch, there is evidence of more intense local reaction, and symptoms persists beyond 48 hrs after removal of patch. Discontinue therapy promptly if symptoms of contact dermatitis occur
- Rivastigmine may increase gastric acid secretion owing to increased cholinergic effect. Monitor patients closely for symptoms of active or occult GI bleeding, especially those with a history of peptic ulcers
- Exaggeration of succinylcholine-type muscle relaxation may occur during anesthesia
- Caution should be exercised in patients with sick sinus syndrome or other supraventricular cardiac conduction conditions, as rivastigmine may exert vagotonic effects on heart rate
- Rivastigmine may induce or worsen extrapyramidal symptoms and parkinsonian symptoms, especially tremors, in patients with dementia associated with Parkinson's disease receiving rivastigmine therapy
- Rivastigmine may cause seizures, urinary obstruction, and worsening of asthma or obstructive pulmonary disease due to its ability to enhance cholinergic activity
- Adverse effects associated with rivastigmine in conjunction with dementia-related impairment of ability to drive and use machines may compromise the patient's ability to drive or operate machinery
- Use with caution in patients with low body weight (<50 kg) due to higher potential for adverse effects
Caution: Use cautiously in
Supplemental Patient Information
- Advise patients to avoid driving or operating machinery during therapy
- Instruct patients regarding proper usage of rivastigmine patch that includes rotating the application site to minimize skin reactions, not using the same site within 14 days, removing the previous day's patch before applying a new one, and replacing the patch every 24 hrs
- Inform patients not to take rivastigmine capsules/oral solution or other drugs with cholinergic effects while wearing the patch
Pregnancy Category:B
Breastfeeding: Safety unknown. As per manufacturer's data, rivastigmine patch has no indication for use in nursing mothers.
Pricing data from www.DrugStore.com in U.S.A.
- Exelon 4.6 MG/24HR PT24 [Box] (NOVARTIS)
30 24hr = $276
90 24hr = $789.97 - Exelon 9.5 MG/24HR PT24 [Box] (NOVARTIS)
30 24hr = $277.99
90 24hr = $817.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
