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What is Rivastigmine
Rivastigmine is a CNS-selective carbamate-type cholinesterase (ChE) inhibitor used for the treatment of mild to severe Alzheimer’s disease.
The drug is structurally distinct from tacrine and donepezil but similar in efficacy.
Like other cholinergic agents, rivastigmine does not alter the long-term prognosis of Alzheimer’s disease, but probably delays the time until institutionalization of the patient.
The drug has been studied for Lewy Body dementia (LBD) and vascular dementia
Brand Name
Exelon | Exelon Patch
Indications
- Alzheimer’s disease
- dementia with Lewy bodies
- Parkinson’s disease dementia
- vascular dementia
Side Effects
- abdominal pain
- agitation
- anemia
- angina
- anorexia
- anxiety
- arthralgia
- asthenia
- ataxia
- atopic dermatitis
- atrial fibrillation
- AV block
- back pain
- blurred vision
- bradycardia
- bronchospasm
- bullous rash
- cataracts
- chest pain (unspecified)
- cholecystitis
- confusion
- constipation
- contact dermatitis
- cough
- dehydration
- depression
- diarrhea
- diplopia
- dizziness
- drowsiness
- dyskinesia
- dyspepsia
- dysphagia
- dysphonia
- dyspnea
- dysuria
- elevated hepatic enzymes
- erythema
- fatigue
- fever
- flatulence
- gastritis
- gastroesophageal reflux
- GI bleeding
- hallucinations
- headache
- heart failure
- hematemesis
- hematuria
- hepatitis
- hot flashes
- hyperhidrosis
- hypersalivation
- hypertension
- hypoesthesia
- hypokalemia
- hyponatremia
- hypotension
- increased urinary frequency
- infection
- insomnia
- intracranial bleeding
- libido increase
- lymphadenopathy
- maculopapular rash
- malaise
- mastalgia
- melena
- migraine
- myalgia
- myasthenia
- myocardial infarction
- nausea
- nightmares
- nocturia
- nystagmus
- ocular hypertension
- orthostatic hypotension
- palpitations
- pancreatitis
- paresthesias
- peptic ulcer
- peripheral edema
- polydipsia
- prostatic hypertrophy
- pruritus
- pseudoparkinsonism
- psoriaform rash
- rash
- renal failure (unspecified)
- restlessness
- seizures
- sinus tachycardia
- Stevens-Johnson syndrome
- suicidal ideation
- supraventricular tachycardia (SVT)
- syncope
- tinnitus
- tremor
- urinary incontinence
- urticaria
- vertigo
- vomiting
- weight loss
Monitoring Parameters
- LFTs
- neurologic function
- weight
Contraindications
- abrupt discontinuation
- anticholinergic medications
- asthma
- AV block
- bladder obstruction
- bradycardia
- breast-feeding
- carbamate hypersensitivity
- cardiac arrhythmias
- cardiac disease
- children
- chronic obstructive pulmonary disease (COPD)
- diarrhea
- driving or operating machinery
- females
- geriatric
- GI bleeding
- GI disease
- GI obstruction
- head trauma
- hepatic disease
- hypotension
- ileus
- increased intracranial pressure
- magnetic resonance imaging (MRI)
- peptic ulcer disease
- pregnancy
- renal failure
- renal impairment
- seizure disorder
- seizures
- sick sinus syndrome
- surgery
- syncope
- tobacco smoking
- urinary tract obstruction
- vomiting
Interactions
- Acebutolol
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Diphenhydramine
- Acrivastine; Pseudoephedrine
- Amantadine
- Ambenonium Chloride
- Amifampridine
- Amoxapine
- Anticholinergics
- Articaine; Epinephrine
- Aspirin, ASA; Caffeine; Orphenadrine
- Atenolol
- Atenolol; Chlorthalidone
- Atracurium
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Bendroflumethiazide; Nadolol
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benztropine
- Beta-blockers
- Betaxolol
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Brimonidine; Timolol
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Bupivacaine
- Bupivacaine Liposomal
- Bupivacaine; Lidocaine
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pyrilamine
- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Carteolol
- Carvedilol
- Chlophedianol; Dexbrompheniramine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlorcyclizine
- Chlordiazepoxide; Clidinium
- Chloroprocaine
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Cholinergic agonists
- Cisatracurium
- Clemastine
- Clozapine
- Cocaine
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Cyclizine
- Cyclobenzaprine
- Cyproheptadine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Promethazine
- Dicyclomine
- Digoxin
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Disopyramide
- Dorzolamide; Timolol
- Doxylamine
- Doxylamine; Pyridoxine
- Esmolol
- Etomidate
- Flavoxate
- Fluoxetine; Olanzapine
- Fospropofol
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Halogenated Anesthetics
- Homatropine; Hydrocodone
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydroxyzine
- Hyoscyamine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Indacaterol; Glycopyrrolate
- Ketamine
- Labetalol
- Levobetaxolol
- Levobunolol
- Levobupivacaine
- Lidocaine
- Lidocaine; Prilocaine
- Maprotiline
- Meclizine
- Mepenzolate
- Meperidine; Promethazine
- Mepivacaine
- Mepivacaine; Levonordefrin
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methocarbamol
- Methohexital
- Methscopolamine
- Metoclopramide
- Metoprolol
- Mivacurium
- Nadolol
- Nebivolol
- Nebivolol; Valsartan
- Nonsteroidal antiinflammatory drugs
- Olanzapine
- Orphenadrine
- Oxybutynin
- Pancuronium
- Penbutolol
- Phenylephrine; Promethazine
- Pindolol
- Prilocaine
- Prilocaine; Epinephrine
- Procaine
- Promethazine
- Propantheline
- Propofol
- Propranolol
- Rocuronium
- Scopolamine
- Sedating H1-blockers
- Solifenacin
- Sotalol
- Succinylcholine
- Tetracaine
- Thiopental
- Thioridazine
- Timolol
- tobacco
- Tolterodine
- Tricyclic antidepressants
- Trihexyphenidyl
- Triprolidine
- Trospium
- Vecuronium
