Rivastigmine belongs to a family of medications known as cholinesterase inhibitors. It is used to treat symptoms of mild to moderately severe Alzheimer'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. Rivastigmine prevents the breakdown of acetylcholine, thereby increasing its levels in the brain. Rivastigmine may improve cognitive function (memory, orientation, and language) and general ability to perform activities of daily living. The rivastigmine patch may take several weeks to begin working, and 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 being given this medication, speak to your doctor. Do not stop using 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 use this medication if their doctor has not prescribed it.

The usual recommended starting dose is to apply one patch of the lowest dose (4.6 mg released every 24 hours) once a day. Your doctor may increase the dose after 4 weeks of treatment. The highest dose recommended is 13.3 mg every 24 hours.

Apply the patch to clean, dry, non-irritated skin on a flat body surface such as the chest, upper back, lower back, or upper arm. Make sure there is no hair, powder, oil, moisturizer, or lotion at the application site. Press the patch firmly in place with the palm of the hand for approximately 30 seconds, making sure the contact is complete, especially around the edges.

Avoid prolonged exposure to excessive sunlight or extreme heat, such as in a sauna or using a heating pad on the same area as the patch. This can increase the amount of medication that is absorbed into the body and cause increased side effects.

Each patch may be worn continuously for 24 hours, after which time the old patch should be removed and a new patch should be applied. Apply the new patch on a different skin site after removal of the previous one and do not apply a new patch to the same spot for at least 2 weeks. Consult the package insert, your doctor, or your pharmacist for specific instructions on how to use and properly dispose of the medication.

Only one patch may be worn at a time. After 24 hours, there is still medication remaining in the patch. If two patches are worn at the same time, there is a high likelihood of severe side effects occurring, including heart attack and death. Do not use the patch if it is cut, damaged, or altered in any way.

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 using the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. If you forget to apply a new rivastigmine patch, remove the old one and apply a new patch as soon as possible. Continue with your regular dosing schedule for your next patch. Do not apply two patches 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 more than 3 days of applying the rivastigmine patch, consult your doctor first before you begin to apply the next patch.

Store this medication at room temperature, in the original packaging. Protect it from light and heat, and keep it out of the reach of children.

Mylan-Rivastigmine Patch 5
Each 5 cm² contains 9 mg of rivastigmine base, with in vivo release rate of 4.6 mg/24 hours. Nonmedicinal ingredients: acrylic adhesive, dimethicone, ethyl acetate, poly(butyl methacrylate, methyl methacrylate), silicone adhesive applied to flexible polyethylene/polyurethane/polyester backing film, brown ink, polyester release liner.

Mylan-Rivastigmine Patch 10
Each 10 cm² contains 18 mg of rivastigmine base, with in vivo release rate of 9.5 mg/24 hours. Nonmedicinal ingredients: acrylic adhesive, dimethicone, ethyl acetate, poly(butyl methacrylate, methyl methacrylate), silicone adhesive applied to flexible polyethylene/polyurethane/polyester backing film, brown ink, polyester release liner.

Do not use rivastigmine patch if you:

• are allergic to rivastigmine or any ingredients of the medication
• are allergic to medications that are similar to rivastigmine
• have had a severe skin reaction when using rivastigmine patches
• have severely reduced liver function

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
• anxiety
• constipation
• dehydration
• diarrhea
• dizziness
• drowsiness
• fatigue
• general feeling of discomfort or illness
• headache
• increased sweating
• itching, irritation, or redness at site of patch application
• loss of appetite
• nausea
• nightmares
• stomach discomfort after a meal
• stomach pain
• trembling
• trouble sleeping
• urinary incontinence
• vomiting
• weakness
• weight loss

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

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

• chest pain
• dehydration (losing too much fluid)
• fainting
• hallucinations (seeing, feeling, or hearing things that are not there)
• high blood pressure
• restlessness
• signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
• 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)
• worsening Parkinson's disease symptoms

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

• blistering of the skin, mouth, eyes, or genitals
• blood in stools or when vomiting
• convulsions (seizures)
• fast, slow, or irregular heartbeat
• severe confusion
• 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
• signs of bleeding in the stomach (e.g., bloody, black, or  tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)
• 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.

Before you begin using 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 use 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.

Incorrect use of medication: Rivastigmine patches are intended to be worn one at a time. Forgetting to remove a patch and applying a second one, can lead to severe, sometimes fatal side effects. If you experience nausea, vomiting, diarrhea, hallucinations, high blood pressure, decreased heart rate or falls, when you previously have tolerated the medication well, this may indicate an incorrect use of the patches.  Report any unusual side effects to your doctor as soon as possible.

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: Decreased liver function or liver disease can lead to this medication to build up in the body, causing side effects. 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 the rivastigmine patch.

Seizures: People who have a history of seizures may experience an increase in seizures when using rivastigmine patch. 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 patch is associated with significant stomach side effects including diarrhea, nausea, vomiting, loss of appetite, and weight loss. If these side effects persist or they 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 3 days' worth of treatment, talk to your doctor about how to safely restart the medication.

Surgery: Rivastigmine increases the effects of some medications that are used during surgery. If you are going to have surgery, make sure you let all the doctors, including dentists, know that you are using rivastigmine patch.

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 rivastigmine 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.

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

• alcohol
• aclidinium
• amiodarone
• antiarrhythmics (e.g., dipyridamole, 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
• dipyridamole
• dronedarone
• fentanyl
• fesoterodine
• fludrocortisone
• glycopyrrolate
• guanfacine
• ipratropium
• ivabradine
• ketotifen
• lacosamide
• lanreotide
• meclizine
• metoclopramide
• moclobemide
• neuromuscular blocking agents (e.g., atracurium, pancuronium, succinylcholine)
• octreotide
• orphenadrine
• 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.