Rivastigmine

What is Rivastigmine for?

Rivastigmine belongs to a class of medications known as acetylcholinesterase inhibitors. It is used to reduce symptoms of mild to moderately severe Alzheimer’s disease, Parkinson’s dementia, or other types of dementia, such as:

• Difficulty in remembering recent events, activities, or the names of familiar people or things
• Poor concentration and judgement

It will not cure or stop the dementia from getting worse, but it may improve the ability to think in some patients and slow down the worsening of these symptoms.

Check with your healthcare professional if you are unsure why you are given this medication.

How should I take or use Rivastigmine?

Follow the instructions on your medication label and take this medication as prescribed by your doctor. Rivastigmine is available as oral capsules and skin patches.

For Rivastigmine capsules:

• It should be taken with or after food and be swallowed whole.

For Rivastigmine patches:

• To use the patches:
  • Remove any old patch first before applying a new one.
  • Before applying the patch, make sure that your skin is clean, dry and hairless, free of any powder, oil, moisturizer or lotion.
  • Apply the patch to dry, non-hairy skin on the upper or lower back, upper arm, or chest.
  • Do not apply the patch to red, irritated, or wounded skin.
  • Do not touch the sticky part of the patch with your fingers.
  • Press down on the patch firmly for 30 seconds with the palm of your hand.
  • Wash your hands with soap and water after applying and removing the patch.
  • If the patch falls off, re-apply a new one immediately. Continue applying a new patch at the same time the next day.
  • Apply the patch at different areas. Avoid applying the patch to the exact same area of skin for at least 14 days to prevent skin irritation.
  • Avoid prolonged exposure to external sources of heat (e.g. excessive sunlight, sauna).
  • Do not remove the patch during bathing or swimming.
  • Do not cut the patch.
  • Each patch is effective for up to 24 hours.
• This medication needs to be taken orally or applied topically regularly for a few weeks before you feel its full benefits. Therefore, do not stop taking or applying this medication even if there are no signs of improvement at the beginning.
• You may check with your doctor on how long you will have to be on this medication.
• Do not stop taking your medication without checking with your healthcare professional.

What should I do if I forget to take or use Rivastigmine?

If you are taking Rivastigmine capsules:

• If you forget to take a dose, take it as soon as you remember. However, if more than half of the time to the next dose has passed, skip the missed dose and take the next dose at your usual timing.
• For example, for a medication to be taken two times daily at 8am and 8pm, and you missed your first dose at 8am, skip the first dose if it is after 2pm, and take your second dose at the usual timing at 8pm. Do not take two doses to make up for the missed dose.

If you are using Rivastigmine patches:

• If you forget to apply the patch, apply one patch immediately. Change the patch at your usual timing the next day. Do not apply 2 patches to make up for the missed dose.

If it has been more than 3 days since you have last taken a dose or applied a patch, consult your doctor before taking or applying it again. You may need to be restarted on a lower dose.

What precautions should I take when taking or using Rivastigmine?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication
• You are pregnant, planning to become pregnant, or breastfeeding. If you are pregnant and/or breastfeeding, your doctor would have discussed the potential benefits and side-effects with you and should you have further questions or concerns, do consult your doctor.
• You are taking any other medications (including those that can be bought without a prescription), supplements, traditional medications and herbal remedies. Some of them may affect how this medication works or cause serious drug interactions.
• You have or have ever had:
  • Other drug allergies or previous skin reaction to medicinal patches/plasters
  • Medical conditions such as:
    • Heart problems, slow or irregular heartbeat
    • Kidney or liver disease
    • Seizures (fits)
    • Respiratory diseases
    • Stomach or intestinal ulcers
    • Difficulty in passing urine

What food or medication should I avoid when I take or use Rivastigmine?

Avoid drinking alcohol while taking Rivastigmine as it can cause excessive sleepiness.

What are some common side effects of Rivastigmine?

• Drowsiness or feeling tired
  • Avoid driving or taking part in activities that require concentration
  • Discuss with your doctor if you can take your medication at a different time of the day
• Nausea or vomiting (more common with oral capsules)
  • Take the medication with or after food
  • Take small but frequent meals and avoid fatty or spicy food
• Diarrhoea
  • Drink plenty of water to replace fluid loss
• Dizziness
  • Get up slowly from a sitting or lying down position
• Skin irritation (for Rivastigmine patch)
  • Change the site of application each time, on skin that is free of wounds or rashes.
  • Avoid applying the patch to the exact same area of skin for at least 14 days.
  • If there is any sign of rash after applying the patch, speak to your doctor if the rash does not go away after 2 days of removing the patch.
• Difficulty sleeping (more common for patch)
  • Discuss with your doctor if you can take your medication at a different time of the day
  • Listen to relaxing music at bedtime
  • Avoid eating or drinking too much before bedtime
  • Limit your caffeine intake (such as coffee, tea or energy drinks) at least 8 hours before bedtime
• Headache
• Loss of appetite, weight loss, stomach discomfort
• Increased sweating

Most of the side effects listed here will improve with time. Speak with your doctor if any of them continues, worsens or affects your daily life.

What are some rare but serious side effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

Rarely this medication may cause:

• Seizures (fits)
• Worsening of Parkinson's symptoms such as tremors
• Severe stomach pain and vomiting of blood or material that looks like coffee grounds; bloody or black tarry stools (signs and symptoms of bleeding from the stomach or intestines)
• Fainting episodes or increased incidence of falling
• Difficulty in holding or passing urine
• Pain in passing urine
• Slow heartbeat
• Fast or irregular heartbeat, fainting episodes (signs and symptoms of an abnormal heart beating rhythm (prolonged QTc interval))
• Seeing or hearing things that are not present (hallucinations)
• Anxiety, agitation or low mood

If you experience any of these side effects, you should stop your medication and inform your healthcare professional immediately.

How should I store Rivastigmine?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children.

How do I throw away Rivastigmine safely?

For Rivastigmine capsules:

• Pack this medication into a trash bag and seal it tightly before throwing it into the rubbish chute or bin.

For Rivastigmine patches:

• Fold the sticky sides together, place the folded patch into the empty pouch of the new patch and discard it into a trash bag.