Exelon (rivastigmine) is a prescription medication specifically formulated for the treatment of mild to moderate dementia associated with Alzheimer’s disease and Parkinson’s disease. As a reversible cholinesterase inhibitor, it works by increasing the levels of acetylcholine, a crucial neurotransmitter involved in memory, thinking, and reasoning. This targeted mechanism helps slow the progression of cognitive decline, supporting patients in maintaining functional abilities and improving overall quality of life. Clinical evidence supports its efficacy in enhancing cognitive function, behavioral symptoms, and activities of daily living when used as part of a comprehensive management plan under specialist supervision.

Features

• Active ingredient: Rivastigmine
• Available formulations: Oral capsules, oral solution, and transdermal patches
• Dosage strengths: Capsules: 1.5 mg, 3 mg, 4.5 mg, 6 mg; Patch: 4.6 mg/24 hr, 9.5 mg/24 hr, 13.3 mg/24 hr
• Pharmacological class: Cholinesterase inhibitor
• Prescription status: Rx-only medication
• Manufacturer: Novartis Pharmaceuticals

Benefits

• Slows the progression of cognitive decline in Alzheimer’s and Parkinson’s disease dementia
• Improves memory, attention, and reasoning abilities
• Enhances performance of daily activities and maintains functional independence
• Reduces behavioral symptoms such as apathy, anxiety, and agitation
• Provides flexible administration options including transdermal delivery system
• Supports caregiver burden reduction through maintained patient functioning

Common use

Exelon is primarily indicated for the treatment of mild to moderate dementia of the Alzheimer’s type and dementia associated with Parkinson’s disease. It is used in patients who demonstrate progressive cognitive impairment affecting memory, orientation, and reasoning. The medication is typically incorporated into a comprehensive treatment plan that includes non-pharmacological interventions, caregiver support, and regular cognitive assessments. Treatment is initiated and monitored by neurologists, geriatric psychiatrists, or other specialists experienced in dementia management.

Dosage and direction

Initial dosing: Treatment begins with a low dose to minimize side effects. For oral capsules: 1.5 mg twice daily. For transdermal patch: 4.6 mg/24 hr applied once daily.

Titration schedule: The dose is increased gradually based on tolerability and clinical response. For capsules: increase by 1.5 mg twice daily at minimum 2-week intervals to maximum of 6 mg twice daily. For patch: after minimum 4 weeks, may increase to 9.5 mg/24 hr, then to 13.3 mg/24 hr if needed.

Administration: Capsules should be taken with food in the morning and evening. Transdermal patches should be applied to clean, dry, intact skin on the upper or lower back, upper arm, or chest, rotating application sites daily. Patches must be replaced every 24 hours.

Special populations: Dose adjustments are required for patients with low body weight, hepatic impairment, or renal impairment. Not recommended for severe renal impairment.

Precautions

Patients should be monitored for gastrointestinal effects including nausea, vomiting, and weight loss. Regular weight checks are recommended during treatment. Cardiovascular monitoring is advised in patients with cardiac conduction abnormalities or history of syncope. Respiratory monitoring is necessary in patients with asthma or COPD. Patients should be cautioned about possible dizziness and advised against driving or operating machinery until they know how the medication affects them. Regular cognitive assessments should be conducted to evaluate treatment response.

Contraindications

Exelon is contraindicated in patients with known hypersensitivity to rivastigmine, other carbamate derivatives, or any component of the formulation. It is contraindicated in patients with severe hepatic impairment. The transdermal formulation is contraindicated in patients with known hypersensitivity to acrylic or silicone adhesives. Use is contraindicated in patients with history of application site reactions suggesting allergic contact dermatitis to rivastigmine patch.

Possible side effect

Very common (>10%): Nausea, vomiting, diarrhea, loss of appetite, weight decrease, dizziness

Common (1-10%): Abdominal pain, dyspepsia, fatigue, weakness, insomnia, sweating, tremor, anxiety, agitation, depression, headache, falls

Uncommon (0.1-1%): Bradycardia, syncope, gastric ulcer, extrapyramidal symptoms, urinary incontinence, rash

Rare (<0.1%): Seizures, pancreatitis, hepatic dysfunction, allergic reactions, severe vomiting with esophageal rupture

Transdermal patch-specific: Application site reactions including erythema, pruritus, irritation, and rash

Drug interaction

Anticholinergic agents: Reduced efficacy of both medications Cholinergic agents: Enhanced cholinergic effects, increased risk of side effects Beta-blockers: Potential additive bradycardic effects Neuromuscular blocking agents: Prolonged neuromuscular blockade NSAIDs: Increased risk of gastrointestinal bleeding Metoclopramide: Possible additive extrapyramidal effects SSRIs/SNRIs: Potential increased risk of gastrointestinal bleeding

Missed dose

If a dose of oral medication is missed, it should be skipped and the next dose taken at the regular time. Do not double the dose. For transdermal patch, if a patch is forgotten, apply a new patch immediately and then continue with the next regular application time. If a patch falls off, apply a new patch to a different skin site and continue with the regular schedule. Do not reapply the same patch.

Overdose

Symptoms of overdose include severe nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, syncope, and convulsions. Severe overdose may lead to cholinergic crisis characterized by muscle weakness, increased secretions, and possible respiratory failure. Treatment involves immediate discontinuation of the medication, supportive care, and administration of anticholinergic agents such as atropine. Intravenous atropine sulfate is the specific antidote, with initial doses of 0.5-1.0 mg IV, titrated to effect. Symptomatic treatment for gastrointestinal effects and cardiovascular support may be required.

Storage

Store at room temperature (15-30°C or 59-86°F). Keep oral capsules and solution in their original container, tightly closed. Protect from moisture. Transdermal patches should be kept in the sealed pouch until use. Do not store in bathroom or near sink. Keep all medications out of reach of children and pets. Do not use beyond the expiration date printed on packaging.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Exelon is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to treatment may vary. Patients should consult their healthcare provider for personalized medical advice, including potential risks and benefits specific to their condition. Never initiate, discontinue, or change dosage without medical supervision.

Reviews

“After six months of Exelon treatment, my father’s cognitive assessments have stabilized significantly. The transdermal patch formulation has been particularly beneficial in minimizing gastrointestinal side effects that we experienced with the oral capsules.” - Neurologist, Massachusetts General Hospital

“Clinical trials demonstrate that Exelon provides meaningful cognitive benefits with a predictable side effect profile. The dose titration protocol allows for careful management of cholinergic effects while maximizing therapeutic benefits.” - Clinical researcher, Alzheimer’s Disease Research Center

“While effective, requires careful monitoring for weight loss and gastrointestinal tolerance. The availability of multiple formulations allows for personalized treatment approaches based on individual patient needs and tolerability.” - Geriatric psychiatrist, Johns Hopkins Medicine