Rivastigmine is a medicine indicated for the treatment of Alzheimer’s and Parkinson’s disease, as it increases the amount of acetylcholine in the brain, an important substance for the functioning of memory, learning and orientation.
This medicine is provided free of charge by the SUS for the treatment of Alzheimer’s, as long as it has a medical indication, or it can be purchased in pharmacies or drugstores in the form of capsules, oral solution or transdermal patches, such as the generic “rivastigmine hemitartrate” or with the trade names Exelon or Vivencia.
Rivastigmine must be used under the advice of a neurologist, and is sold upon presentation of a medical prescription and retention of a copy of the prescription by the pharmacy.
What is it for
Rivastigmine is indicated for the treatment of mild to moderately severe dementia caused by:
- Alzheimer
- Parkinson’s disease.
Rivastigmine does not cure Alzheimer’s or Parkinson’s disease, but it helps improve cognition and memory, and delay the progression of the disease.
This medicine should be used under the advice of a neurologist, with regular medical monitoring to assess the effect of rivastigmine and the emergence of side effects.
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How to use
The way to use rivastigmine varies depending on its presentation and includes:
1. Rivastigmine capsules
The capsules are available in different doses and may contain 1.5 mg, 3 mg, 4.5 mg or 6 mg of rivastigmine and must be taken orally, along with morning and evening meals.
The normally recommended starting dose for adults is 1 capsule of rivastigmine 1.5 mg, twice a day.
This dose can be increased by the doctor to 3 mg, twice a day, after 2 weeks of treatment. Likewise, the doctor can increase the dose at intervals of at least 2 weeks, to 4.5 mg or 6 mg, twice a day, which varies depending on the person’s tolerance to the treatment.
The normally recommended maintenance dose is 1.5 mg to 6 mg of rivastigmine twice a day.
The maximum daily dose should not exceed 6 mg per day.
2. Rivastigmine oral solution
The 2 mg/mL rivastigmine oral solution must also be taken orally, without diluting it with water or other liquid, and the dose must be measured using the dosing syringe provided in the package.
The initial dose of rivastigmine oral solution is 1.5 mg twice a day. In the case of people with greater sensitivity to cholinergic medications, an initial dose of 1 mg, twice a day, is recommended.
These doses can be gradually increased by the doctor at intervals of at least 2 weeks, to 3 mg, 4.5 mg or 6 mg, twice a day.
The maintenance dose varies from 1.5 mg to 6 mg, twice a day, and the maximum daily dose should not exceed 6 mg, twice a day.
3. Rivastigmine transdermal patch
The transdermal patch (Exelon patch or Vivencia patch) may contain 9 mg, 18 mg or 27 mg of rivastigmine, and should be used by applying the patch under the skin of the upper or lower back, arm or chest, after washing and drying well the skin. You must press the sticker onto the skin for at least 30 seconds so that it sticks well.
The patch must be changed every 24 hours, and it is recommended to vary the application site to avoid skin irritation, and you must wait at least 14 days to apply it to the same location.
The recommended initial dose is 1 transdermal patch of 9 mg of rivastigmine, which should remain on the skin for 24 hours and be changed the next day.
After every 4 weeks of treatment, the doctor may recommend gradually increasing the dose to the 18 mg or 27 mg transdermal patch, once a day, changed every 24 hours.
The generally recommended maintenance dose is 1 patch of rivastigmine 18 mg per day.
The rivastigmine transdermal patch should not be applied to irritated, red, wound, cut or hairy skin.
Possible side effects
The most common side effects of rivastigmine are nausea, vomiting, stomach pain, diarrhea, loss of appetite, dizziness, headache, anxiety, insomnia, depression, urinary incontinence, urinary tract infection, or excessive sweating.
It is important to take the person to the hospital if diarrhea or vomiting is severe, as this can cause dehydration.
In addition, tremors or worsening of Parkinson’s disease may also occur.
In the case of the transdermal patch, allergic reactions, redness, itching or swelling may occur at the site of application.
Who shouldn’t use
Rivastigmine should not be used by children, pregnant or breastfeeding women or by people who are allergic to rivastigmine or any of the components of the formula.
This remedy should be used with caution by people who have already had asthma attacks or obstructive lung diseases.
Furthermore, rivastigmine should also be used with caution and only if indicated by a doctor for people with heart disease, such as sinus node disease, sinoatrial or atrioventricular block, for example.
