8 Rivastigmine (Exelon) Side Effects You Should Know About

If you or a loved one have been diagnosed with Alzheimer’s disease or Parkinson’s disease, a healthcare provider may recommend a medication like rivastigmine (Exelon). Rivastigmine works by increasing a chemical in the brain that helps nerve cells communicate. For some people, it can help manage the symptoms of Alzheimer’s or Parkinson’s-related dementia.

Rivastigmine is available as a twice-daily oral capsule and once-daily patch. The best choice for you or your loved one can depend on preferences and cost. But for some people, the decision comes down to side effects. Nausea and vomiting tend to be more common with the capsules. And the patches are more likely to cause skin irritation and reactions.

Let’s discuss eight of the common and serious rivastigmine side effects you should consider.

Promotion disclosure

Rivastigmine

Avg retail price

$167.40(Save 87.71%)

GoodRx discount

$20.58

See all discounts

How it works

Use GoodRx to find medications, pharmacies, and discounts.

GoodRx discounts can help you pay less for your prescription.

Bring your free coupon or savings card to the pharmacy.

1. Nausea and vomiting

Nausea and vomiting are common rivastigmine side effects. Almost half of people taking rivastigmine capsules during clinical trials reported nausea. But it wasn’t as common with the patches. Similarly, vomiting was also more common with the capsules than patches.

You may experience nausea and vomiting when first starting rivastigmine, or when your dose is increased. Your healthcare provider may increase your dose slowly over time to help minimize these effects. Rivastigmine capsules should be taken with meals, which may also help.

Let your healthcare provider know if your nausea and vomiting becomes severe, as this can result in dehydration. If you’re unable to tolerate the capsules, they may switch you to the patches to see if it makes a difference. Don’t attempt to stop and restart the medication on your own.

2. Diarrhea

Diarrhea is another common rivastigmine side effect. Similar to nausea and vomiting, diarrhea was reported more frequently with the capsules than the patches during clinical trials.

Tips for managing diarrhea include staying hydrated and avoiding foods that can make it worse. This includes fatty, fried, and fibrous foods. Following the BRAT diet with simple, bland foods may help.

If you’re taking rivastigmine capsules, changing to the patch may be an option. If your diarrhea is severe or won’t go away, let your healthcare provider know. They may recommend stopping rivastigmine. But don’t attempt to do this on your own without their guidance.

3. Decreased appetite

Taking rivastigmine can cause you to lose your appetite. This may be due to stomach-related side effects you’re experiencing, like nausea and vomiting. As mentioned above, these side effects tend to be more common with the capsules.

If you notice a decreased appetite and/or weight loss while taking rivastigmine, let your healthcare provider know. They may suggest adding a nutrition supplement drink to your diet, like Ensure or Boost. If your appetite isn’t coming back, they may need to change your dose. Or they may switch you to the patches if you’re taking the capsules.

4. Headache

It’s possible to get headaches when you’re taking rivastigmine. This can happen with the capsules or patches. There are a few things you can do to provide relief if headaches become bothersome. For example, staying hydrated and getting enough sleep may be helpful.

Your healthcare provider may also recommend taking over-the-counter (OTC) medications as an option. But if your headaches are severe or won’t go away, they may instruct you to stop taking rivastigmine.

5. Dizziness

Dizziness is another common side effect of rivastigmine. It also appears to be more common with the capsules than patches.

If you get dizzy, it’s important to find a safe place to sit or lie down to avoid falling. Drinking plenty of water or eating a snack may help if you’re dehydrated or hungry.

Conditions like low blood pressure (hypotension) and low blood sugar (hypoglycemia) may also cause dizziness. Let your healthcare provider know if you’re feeling dizzy while taking rivastigmine.

6. Fatigue

Fatigue is another reported side effect of rivastigmine capsules and patches. If you’re experiencing fatigue, you may feel tired or weak.

There are several things you can do to help you feel like you have more energy. Eating healthy and engaging in physical activity can improve symptoms of fatigue. Getting enough rest and relaxation can also help. If your fatigue is severe, your healthcare provider may change your dose or have you stop taking rivastigmine. Don’t try to change your dose or stop the medication on your own.

7. Skin reactions

You may experience some skin irritation where you apply rivastigmine patches. This can happen with many medicated patches.

If you experience irritation, it often improves within 48 hours of removing the patch. And placing your patch on different areas of your skin can help reduce the risk of excessive irritation.

However, it’s not normal for the rash to spread, develop bumps or swelling, or continue for more than 48 hours. These can be signs of allergic contact dermatitis, which is possible with rivastigmine patches. While rare, rashes have also been reported with the capsules. If you have these symptoms, tell your healthcare provider right away.

8. Extrapyramidal symptoms

Extrapyramidal symptoms (EPS) are different types of uncontrollable body movements. They can happen as a side effect from rivastigmine capsules or patches. And if you’re already experiencing EPS, rivastigmine can potentially make them worse.

Examples of EPS include:

• Akathisia: a sense of urges to move or restlessness

• Dystonia: involuntary muscle movements that cause unusual positions or repetitive motions

• Tardive dyskinesia: uncontrollable face or tongue movements

• Parkinsonism: can resemble symptoms of Parkinson’s disease and includes tremors in the hands, feet, or trunk area

These symptoms can be especially concerning if you have Parkinson’s disease, since it may seem like your condition is getting worse. EPS doesn’t always happen with rivastigmine. But if you have any of these symptoms, let your healthcare provider know. They can help manage these issues.

When should I contact my healthcare provider about side effects from rivastigmine?

If you’re experiencing any side effects from rivastigmine, you should contact your healthcare provider. They can recommend ways to safely manage them.

In some cases, they may have you skip a few rivastigmine doses and restart it at the same dose or lower. But it’s important that you don’t attempt to do this on your own.

Mild, temporary side effects can be treated at home and may resolve on their own. Severe or persistent side effects may require dose adjustments or medication changes. In rare cases, you may need immediate medical attention.

If you have a spreading or worsening rash, let your healthcare provider know right away. This could mean that you are having an allergic skin reaction.

Why trust our experts?

Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Our editorial standards

Meet our experts