Rivastigmine is associated with gastrointestinal side effects including nausea and vomiting, anorexia, and weight loss.
Cholinesterase inhibitors increase gastric acid secretion due to increased cholinergic activity.
As a cholinesterase inhibitor, rivastigmine is likely to exaggerate succinylcholine-type muscle relaxation during anesthesia. Agents that increase cholinergic activity may cause bradycardia. Caution is recommended in patients with sick sinus syndrome or other supraventricular conduction disorders. Rivastigmine was not associated with an increased incidence of cardiovascular adverse events, heart rate or blood pressure changes, or ECG abnormalities in clinical trials. Agents that increase cholinergic activity may cause urinary obstruction, cause seizures, or exacerbate asthma or chronic obstructive pulmonary disease.