Rivastigmine (patient information)

# Overview
Rivastigmine is used to treat dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and may cause changes in mood and personality) in people with Alzheimer's disease (a brain disease that slowly destroys the memory and ability to think, learn, communicate and handle daily activities). Rivastigmine is also used to treat dementia in people with Parkinson's disease (a brain and nervous system disease with symptoms of slowing of movement, muscle weakness, shuffling walk, and loss of memory). Rivastigmine is in a class of medications called cholinesterase inhibitors. It improves mental function (such as memory and thinking) by increasing the amount of a certain natural substance in the brain.

# How should this medicine be used?
Rivastigmine comes as a capsule and solution (liquid) to take by mouth. It is usually taken twice a day with meals in the morning and evening. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take rivastigmine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor will start you on a low dose of rivastigmine and slowly increase your dose, not more than once every 2 weeks.
Rivastigmine may improve the ability to think and remember or slow the loss of these abilities, but does not cure Alzheimer's disease or dementia in people with Parkinson's disease. Continue to take rivastigmine even if you feel well. Do not stop taking rivastigmine without talking to your doctor.
If you are taking rivastigmine oral solution, ask your pharmacist or doctor for a copy of the manufacturer's instructions for use. Carefully read these instructions. Always use the oral dosing syringe that comes with rivastigmine solution to measure your dose. Talk to your doctor or pharmacist if you have questions about how to measure your dose of rivastigmine solution.
Rivastigmine oral solution may be swallowed directly from the syringe or mixed with a liquid before use. Mix it with a small glass of water, cold fruit juice, or soda. Be sure to stir the mixture completely. Do not mix this medication with any liquid other than the ones listed. If the medication is mixed with water, juice, or soda, it must be taken within 4 hours.
To take a dose of rivastigmine solution, follow these steps:
- Remove the oral dosing syringe that came with this medication from its protective case.
- Push down and twist off the child-resistant cap to open the bottle of rivastigmine solution.
- Put the tip of the oral syringe into the white stopper opening on top of the bottle.
- While holding the syringe straight up, pull up on the plunger to the mark on the syringe that equals your dose.
- Check the liquid in the syringe for air bubbles. If there are large air bubbles, gently move the syringe plunger up and down a few times. Do not worry about a few tiny air bubbles.
- Make sure the plunger is on the mark on the syringe that equals your dose.
- Remove the oral syringe from the bottle by pulling up on it.
- Swallow your dose from the syringe directly, or mix it with the liquid you have chosen. Drink or swallow all of the solution.
- Wipe off the outside of the oral syringe with a clean tissue, and put the syringe back into its case.
- Close the child-resistant cap on the bottle of medication.

# Other uses for this medicine
Rivastigmine is also used sometimes to treat Lewy body dementia (a condition in which the brain develops abnormal protein structures, and the brain and nervous system are destroyed over time). Talk to your doctor about the possible risks of using this medication for your condition.

# What special precautions should I follow?
Before taking rivastigmine:
- tell your doctor and pharmacist if you are allergic to rivastigmine, neostigmine (Prostigmin), physostigmine (Antilirium, Isopto Eserine), pyridostigmine (Mestinon, Regonol), any other medications, or any of the ingredients in rivastigmine solution. Ask your pharmacist for a list of the ingredients..
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antihistamines; aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); bethanechol (Duvoid, Urabeth, Urecholine); ipratropium (Atrovent); and medications for Alzheimer's disease, glaucoma, irritable bowel disease, motion sickness, myasthenia gravis, Parkinson's disease, ulcers, or urinary problems. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had asthma, an enlarged prostate or other condition that blocks the flow of urine, ulcers, abnormal heart beats, or other heartor lung disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking rivastigmine, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking rivastigmine.

# What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.

# What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
If you miss taking rivastigmine for more than a few days, talk to your doctor before starting to take it again. You will probably have to restart taking it at a lower dose.

# Side effects

## Mild side effects
Rivastigmine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- nausea
- vomiting
- loss of appetite
- heartburn or indigestion
- stomach pain
- weight loss
- diarrhea
- constipation
- gas
- weakness
- dizziness
- headache
- extreme tiredness
- lack of energy
- tremor or worsening of tremor
- increased sweating
- difficulty falling asleep or staying asleep
- confusion

## Severe side effects
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
- fainting
- black and tarry stools
- red blood in stools
- bloody vomit
- vomiting material that looks like coffee grounds
- difficulty urinating
- painful urination
- seizures
- depression
- anxiety
- aggressive behavior
- hearing voices or seeing things that do not exist)
- uncontrollable movements and muscle contractions
Rivastigmine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# What storage conditions are needed for this medicine?
Keep this medication in the container it came in, tightly closed, and out of reach of children.Store it at room temperature and away from excess heat and moisture (not in the bathroom). Store rivastigmine solution in an upright position. Do not place rivastigmine solution in the freezer or allow rivastigmine solution to freeze.Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- nausea
- vomiting
- increased saliva
- sweating
- slow heart beat
- inability to hold urine
- slowed thinking and movement
- dizziness
- fainting
- blurred vision
- difficulty breathing
- loss of consciousness
- seizure

# What other information should I know?
Keep all appointments with your doctor.
Do not let anyone else take your medication.Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Exelon