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Brand Name: Exelon
Drug Class: Reversible cholinesterase inhibitor
Available in: Capsules, oral solution
Available OTC? No
As Generic? No

Side Effects

Serious: Possible gastrointestinal bleeding. No other serious side effects are associated with the use of rivastigmine.

Common: Significant nausea, vomiting, loss of appetite, and weight loss. Other common side effects include heartburn, weakness, dizziness, diarrhea, abdominal pain.

Less Common: Increased sweating, fatigue, malaise, headache, drowsiness, tremor, flatulence, insomnia, depression, anxiety.

Principal Uses

To treat mild to moderate Alzheimer disease.

How the Drug Works

The exact mechanism of action is unknown. However, rivastigmine is believed to work by inhibiting acetylcholinesterase enzymes, which reduces the breakdown of acetylcholine, a brain chemical crucial to memory. Acetylcholine deficiency is thought to result in memory loss associated with Alzheimer disease.


To start, 1.5 mg twice a day. After two weeks of treatment, your doctor may increase the dose to 3 mg twice a day. The dose may be further increased at no less than 2-week intervals to 4.5 mg twice a day and then to the maximum dose of 6 mg twice a day, if tolerated.

Onset of Effect


Duration of Action


Dietary Advice

Rivastigmine should be taken with meals in the morning and evening. The oral solution may be swallowed directly from the syringe or mixed with a small glass of water, cold fruit juice, or soda.


Store in a tightly sealed container away from heat, moisture, and direct light. Do not freeze the oral solution.

If You Miss a Dose

Take it as soon as you remember, unless the time for your next scheduled dose is within the next 2 hours. If so, do not take the missed dose. Take your next scheduled dose at the proper time and resume your regular dosage schedule. Do not double the next dose. If therapy has been interrupted for several days or longer, consult your physician.

Stopping the Drug

The decision to stop taking the drug should be made in consultation with your physician.

Prolonged Use

No problems are expected with long-term use.


Over 60: No special problems are expected.

Driving and Hazardous Work: Do not drive or engage in hazardous work until you determine how the medicine affects you.

Alcohol: Avoid alcohol while using this medication.

Pregnancy: In some animal studies, large doses of rivastigmine were shown to cause problems. Before you take rivastigmine, tell your doctor if you are pregnant or plan to become pregnant.

Breast Feeding: It is not known whether rivastigmine passes into breast milk; caution is advised. Consult your doctor for specific advice.

Infants and Children: Rivastigmine is not intended for use in children.

Special Concerns: Before you have any surgery or dental or emergency treatment, tell the doctor or dentist in charge that you are taking rivastigmine. Rivastigmine will not cure Alzheimer disease and will not stop the disease from getting worse, but it will improve cognitive ability of some patients. Caretakers should be instructed in the correct way to administer the oral solution of rivastigmine.


Symptoms: Severe nausea, vomiting, increased salivation, sweating, slow heartbeat, low blood pressure, irregular breathing, unconsciousness, increased muscle weakness, death.

What to Do: Call your doctor, emergency medical services (EMS), or the nearest poison control center immediately.

Drug Interactions

Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of peptic ulcer or gastrointestinal bleeding when taken with rivastigmine.

Food Interactions

No known food interactions.

Disease Interactions

Caution is advised when taking rivastigmine.

Consult your doctor if you have any of the following: asthma, epilepsy or a history of seizures, heart problems, intestinal blockage, stomach or duodenal ulcer, liver disease, or urinary problems.


From The Johns Hopkins Consumer Guide to Drugs. You can order this book now on our secure server.


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