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(riv-vah-STIGG-meen TAR-trate)
Exelon
Capsules: 1.5 mg (as base), 3 mg (as base), 4.5 mg (as base), 6 mg (as base)
Solution: 2 mg/mL (as base)
Class: Cholinesterase inhibitor

 Actions Unknown; however, may increase acetylcholine by inhibiting acetylcholinesterase, thereby increasing cholinergic function.

 Indications Treatment of mild-to-moderate dementia of the Alzheimer’s type.

 Contraindications Hypersensitivity to rivastigmine or carbamate derivatives.

 Route/Dosage

ADULTS: PO 1.5 mg twice daily initially, then the dose may be increased by increments of 1.5 mg twice daily at intervals of ³ 2 wk (max, 6 mg twice daily).

 Interactions

Anticholinergic drugs: Possible reduction in anticholinergic effects. Cholinesterase inhibitors, cholinomimetics: Synergistic effects may occur.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Hypertension; syncope; chest pain; peripheral edema; hypotension; postural hypotension; cardiac failure; atrial fibrillation; bradycardia; palpitation; angina pectoris; MI; AV block; bundle branch block; sick sinus syndrome; cardiac arrest; supraventricular tachycardia; peripheral ischemia; pulmonary embolism; thrombosis; deep thrombophlebitis; aneurysm; intracranial hemorrhage; extrasystoles; tachycardia. CNS: Dizziness; headache; insomnia; confusion; depression; anxiety; somnolence; hallucination; tremor; aggression; vertigo; agitation; nervousness; delusion; paranoid reaction; abnormal gait; ataxia; paresthesia; convulsions. DERMATOLOGIC: Increased sweating; rash (eg, maculopapular, eczema, bullous, exfoliative, psoriaform, erythematous). EENT: Rhinitis; coughing; pharyngitis; bronchitis; tinnitus; cataract. GI: Nausea; vomiting; anorexia; diarrhea; dyspepsia; abdominal pain; constipation; hemorrhoids; flatulence; eructation; fecal incontinence; gastritis. GU: Urinary tract infection; urinary incontinence; hematuria. HEMATOLOGIC: Anemia; epistaxis; hypochromic anemia; thrombocytopenia; lymphadenopathy; leukocytosis. HEPATIC: Abnormal hepatic function; cholecystitis. METABOLIC: Weight decrease; dehydration; hypokalemia. RESPIRATORY: Upper respiratory tract infection; bronchoconstriction. OTHER: Asthenia; accidental trauma; fatigue; malaise; flu-like syndrome; back pain; arthralgia; pain; bone fracture; infection; arthritis; leg cramps; myalgia; fever; edema; allergy; hot flashes.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children Safety and efficacy not established. Concomitant medical conditions: Increases cholinergic activity and, therefore, can affect other organ systems, possibly leading to bradycardia, bladder outflow obstruction, increased gastric acid secretion, or bronchoconstriction.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer twice daily, preferably with morning and evening meal.
  • Dose is gradually increased at 2-wk intervals.
  • Administer oral solution using the dosing syringe provided with each bottle of medication.
  • Dose of oral solution may be swallowed directly from syringe or first mixed with a small glass of water, cold fruit juice, or soda. If mixed with water, juice, or soda, stir completely and have patient drink entire mixture.
  • Oral solution and capsules can be interchanged at equal doses.
  • Store capsules and oral solution < 77°F (25°C). Store solution upright and protect from freezing.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Evaluate patient’s mental status and function prior to initiation of therapy.
  • Monitor patient for signs of improvement after therapy is started.
  • Assess patient for GI, CNS, CV, psychiatric, and general body side effects. Report to health care provider if noted and significant.
OVERDOSAGE: SIGNS & SYMPTOMS
  Cholinergic crisis (eg, severe nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, muscle weakness, collapse, convulsions), death

 Patient/Family Education

  • Explain name, dose, action, and potential side effects of drug.
  • Advise patient or caregiver that medication is started at a low dose and gradually increased (no more often than every 2 wk) as tolerated to reduce the risk of severe nausea and vomiting occurring.
  • Advise patient or caregiver that medication is taken 2 times a day, preferably with the morning and evening meal.
  • Ensure that patient or caregiver understands the correct procedure for administering the oral solution. Urge patient or caregiver to review Instruction Sheet included in each package of oral solution.
  • Advise patient or caregiver that oral solution may be swallowed directly from syringe or first mixed with a small glass of water, cold fruit juice, or soda. If mixing with water, juice, or soda, stir the mixture well and drink entire mixture.
  • Advise patient or caregiver if nausea, vomiting, abdominal pain, or anorexia occur during treatment to discontinue medication for several doses and then restart at the same or next lower dose level.
  • Caution patient or caregiver that if medication has been stopped for several days or longer to restart at the lowest dose and gradually increase to the current dose.
  • Advise patient or caregiver that nausea and vomiting are the most common side effects and that taking the medication with food may reduce these side effects. If nausea and vomiting become a problem the patient or caregiver should inform the health care provider.
  • Advise patient, family, and caregiver not to discontinue the drug or change the dose unless advised to do so by the health care provider.
  • Advise patient, family, and caregiver that this drug does not alter the Alzhemer’s process and that the effectiveness of the medication may lessen over time.
  • Advise patient or caregiver that follow-up visits may be required to monitor therapy and to be sure and keep appointments.

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