Rivastigmine (exelon)

A similar treatment to Aricept (donepezil) and Reminyl (Galantamine). One of the messengers that carry instructions around the brain is called acetylcholine. Research has shown that there is not enough of this chemical in the brains of people who suffer with Alzheimer’s disease. An enzyme called aceycholinesterase breaks this chemical down and the drug Rivastigmine (Exelon) can reduce this break down. Therefore Rivastigmine increases the amount of acetylcholine in the brain. Rivastigmine does not delay, stop or cure Alzheimer’s dementia; but improves early symptoms of the disease

Rivastigmine (Exelon) treatment should be initiated by the consultant or a specialist clinician, although GPs may continue prescribing. Patients should be started on initially 1.5mg tablets twice daily, increasing in step of one tablet twice daily at intervals of at least 2 weeks according to response and tolerance. Usual range of drug treatment is 3 to 6 mg tablets twice daily

Rivastigmine has proven to be more effective for patients with mild to moderate symptoms of Alzheimer’s Disease. Alzheimer patients tend to have greater behavioural, sensorial, global and daily living activity improvements in higher dosage

Not all the Alzheimer’s patients improve with Rivastigmine, especially patients with more severe symptoms, so assessment may be done by your specialist clinician and if, after 3 months of treatment, patients do not respond, Rivastigmine could be discontinued

The main side effects of Rivastigmine are: gastrointestinal side effects (nausea, vomiting, and diarrhoea), fatigue, dizziness, muscle aching, urinary incontinence, sweating and vision disorders. They are usually mild to moderate, of short duration and responsive to dosage reduction. It is important to follow the dosage range and the step up to minimise side effects. You will find a list of less common side effects in the leaflet given with the medication. Please make sure you have a copy the first time the medication is prescribed

If treatment has to be interrupted for longer than several days, due to severe nausea, diarrhoea or vomiting; treatment should be reinitiated with the lowest daily dose increasing the dosage gradually to reduce the possibility of severe vomiting

Rivastigmine should be prescribed with caution for:

• pregnant women or those who are breastfeeding
• gastric or duodenal ulcers (and those at risk of developing ulcers)
• sufferers of arrhythmias ( such as sick sinus syndrome or other conduction abnormalities)
• have history of asthma or chronic obstructive pulmonary disease,
• suffer from extrapyramidal symptoms, as they may exacerbate them, especially in parkinson’disease patients
• have history of seizures
• suffer from bladder obstructions
• suffer from liver or kidney problems

If other medication is required, such as cold remedies, do not forget to check with your pharmacist

Reproduced with kind permission of Maria Sanchez our Consultant Pharmacist