How does this medication work? What will it do for me?

Rivastigmine belongs to a family of medications known as cholinesterase inhibitors. It is used to treat symptoms of mild-to-moderate Alzheimer's disease. It is also used to treat mild-to-moderate dementia (problems with brain functions such as memory, language, and thinking) associated with Parkinson's disease.

Alzheimer's disease is caused by the constant degeneration of certain nerve cells in the brain that make a chemical called acetylcholine. This chemical is thought to be important for the processes of learning and memory. Parkinson's disease dementia is also believed to be related to a shortage of acetylcholine. Rivastigmine prevents the breakdown of acetylcholine, thereby increasing its levels in the brain. Rivastigmine provides the most benefit when there are enough cells producing adequate levels of acetylcholine (i.e., in mild-to-moderate disease) but provides little benefit when the disease becomes severe.

Rivastigmine may improve cognitive function (memory, orientation, and language) and general ability to perform activities of daily living. Rivastigmine may take up to 12 weeks to begin working, but individual response varies.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

ratio-Rivastigmine is no longer being manufactured for sale in Canada. For brands that may still be available, search under rivastigmine. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The dose of rivastigmine can vary, but the recommended starting dose is 1.5 mg twice daily with food, increased gradually to the best tolerated dose. The highest dose recommended is 6 mg twice a day.

Rivastigmine should be taken twice a day, once with breakfast and once with the evening meal. The capsules must be swallowed whole and should be taken on a regular basis every day in order to be effective.

The oral solution can be withdrawn from its container using the syringe provided. It can be swallowed directly from the syringe or mixed with a small amount of water, cold fruit juice, or soda. If you mix it into a beverage, make sure to stir and drink the full amount.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice. If you miss 3 or more days of medication, contact your doctor.

Store rivastigmine at room temperature, away from direct sunlight and heat, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to rivastigmine or any of the ingredients of the medication
  • are allergic to medications that are similar to rivastigmine
  • have severely reduced liver function
  • have had a reaction at the application site to rivastigmine patche

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • accidental falls
  • agitation or confusion
  • constipation
  • difficulty sleeping
  • dizziness, sleepiness, or drowsiness
  • headache
  • gas
  • increased saliva
  • increased sweating
  • lightheadedness
  • loss of appetite
  • nausea, vomiting, diarrhea, or stomach discomfort after a meal
  • nightmares
  • trembling
  • weakness, fatigue, or a general feeling of being unwell
  • weight loss
  • worsening of Parkinson's disease symptoms (e.g., stiffness or difficulty in carrying out movements)

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • anxiety
  • decreased control of movement
  • fainting
  • hallucinations (seeing, feeling, or hearing things that are not there)
  • high blood pressure
  • restlessness
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • skin rash or itching
  • stiff limbs, trembling hands, body spasms
  • symptoms of a stomach ulcer (e.g., stomach pain, burning, discomfort, or bloating)
  • symptoms of a urinary tract infection (e.g., painful or burning urination, frequent urination, or cloudy urine)
  • urine leakage
  • worsening Parkinson's disease symptoms

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • chest pain
  • blistering of the skin, mouth, eyes, or genitals
  • blood in stools or when vomiting
  • convulsions (seizures)
  • dehydration (losing too much fluid)
  • fast, slow, or irregular heartbeat
  • severe vomiting
  • signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
  • symptoms of a heart attack (e.g., pain, pressure, or discomfort in the chest, neck, back, or jaw; sweating; shortness of breath; nausea; lightheadedness; or feelings of anxiety, fear, or denial)
  • symptoms of a stroke (e.g., sudden paralysis or numbness, difficulty speaking or understanding speech, loss of coordination, severe headache, or vision changes)
  • symptoms of inflammation of the pancreas (e.g., severe stomach pain with nausea and vomiting)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Breathing conditions: Rivastigmine may cause breathing problems to worsen. If you have a history of asthma or obstructive lung disease (e.g., emphysema, chronic bronchitis), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: This medication may cause dizziness or drowsiness, mainly when starting treatment or increasing the dose. Your doctor will advise you whether it is safe for you to drive vehicles and operate machinery. If you feel dizzy or drowsy, do not drive, use machines, or perform any other tasks that require your attention.

Heart disease: People with certain types of heart disease (e.g., congestive heart failure, coronary artery disease) are more likely to experience symptoms of heart disease as a result of rivastigmine slowing down the heart rate. If you have heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication. People with severely reduced liver function should not use this medication.

Low body weight: People who weigh less than 50 kg may experience more side effects than people who weigh more than 50 kg. Discuss with your doctor any concerns you may have about using rivastigmine.

Seizures: People who have a history of seizures may experience an increase in seizures when using rivastigmine. If you have a history of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stomach problems: The use of rivastigmine is associated with significant stomach side effects including nausea, vomiting, loss of appetite, and weight loss. If these side effects persist or bother you, speak to your doctor. If you have a history of stomach ulcers or are at risk of developing ulcers discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stopping and restarting treatment: If you miss more than several days' worth of treatment, talk to your doctor about how to safely restart the medication.

Surgery: If you are going to have surgery, make sure you let all the doctors, including dentists, know that you are using rivastigmine.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if rivastigimine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between rivastigmine and any of the following:

  • alcohol
  • aclidinium
  • amiodarone
  • antiarrhythmics (e.g., disopyramide, flecainide, propafenone, quinidine)
  • antihistamines (e.g., azelastine, brompheniramine, cetirizine, chlorpheniramine, diphenhydramine, hydroxyzine, loratadine)
  • antipsychotic medications (e.g., aripiprazole, chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • atropine
  • benztropine
  • beta-blockers (e.g., atenolol, metoprolol, propranolol)
  • bethanechol
  • ceritinib
  • clonidine
  • corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
  • crizotinib
  • cyclobenzaprine
  • darifenacin
  • digoxin
  • diltiazem
  • dimenhydrinate
  • dipyridamole
  • dronedarone
  • fentanyl
  • fesoterodine
  • fludrocortisone
  • glycopyrrolate
  • guanfacine
  • ipratropium
  • ivabradine
  • ketotifen
  • lacosamide
  • lanreotide
  • meclizine
  • metoclopramide
  • moclobemide
  • neuromuscular blocking agents (e.g., atracurium, pancuronium, succinylcholine)
  • octreotide
  • other cholinesterase inhibitors (e.g., donepezil, galantamine)
  • oxybutynin
  • pasireotide
  • pilocarpine
  • pizotifen
  • scopolamine
  • solifenacin
  • sphingosine 1-phosphate receptor (S1P) receptor inhibitors (e.g., fingolimod, ozanimod, ponesimod, siponimod)
  • tiotropium
  • tizanidine
  • tofacitinib
  • tolterodine
  • tranylcypromine
  • tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
  • trihexyphenidyl
  • trospium
  • umeclidinium
  • verapamil

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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