Alzheimer’s Medications: Comparing Your Treatment Options
Alzheimer’s-related dementia can be treated with oral, topical, and IV medications. Learn about the best treatments for Alzheimer’s, including side effects.
rivastigmine
Used for Alzheimer's Disease, Parkinson's Disease
Used for Alzheimer's Disease, Parkinson's Disease
Rivastigmine is used to help adults with symptoms of dementia related to Alzheimer's disease or Parkinson's disease. It belongs to the drug class called acetylcholinesterase inhibitors. Rivastigmine capsules are taken by mouth twice per day. The dosage typically depends how well you can tolerate the medication. Common side effects include nausea, vomiting, and diarrhea. The brand-name version of the capsule, Exelon, is no longer available. But you can still get the capsules as a generic.
What is Rivastigmine?
What is Rivastigmine used for?
- Dementia related to Alzheimer's disease or Parkinson's disease
How Rivastigmine works
Rivastigmine is an acetylcholinesterase inhibitor. It's not completely clear how it helps treat dementia. But it's thought to work by blocking a protein called cholinesterase. This allows a natural chemical called acetylcholine to stick around in your brain longer. It helps your brain cells communicate with each other better, which is important for memory, attention, and thinking skills.
Drug facts
| Common Brands | Exelon |
|---|---|
| Drug Class | Acetylcholinesterase inhibitor |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
Side effects of Rivastigmine
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nausea (47%)
- Vomiting (31%)
- Dizziness (21%)
- Diarrhea (19%)
- Headache (17%)
- Loss of appetite (17%)
- Stomach pain (13%)
Less Common Side Effects
- Upset stomach
- Tiredness
- Trouble sleeping
- Confusion
- Depression
- Anxiety
- Hallucinations
- Aggressive behavior
- Shaking (tremor)
- Weight loss
- More sweating
- Fainting
- Urinary tract infection (UTI)
Rivastigmine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic skin reaction: rash, skin redness, swelling
More on Rivastigmine side effects
The following Rivastigmine side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Bladder pain
bloody or cloudy urine
difficult, burning, or painful urination
frequent urge to urinate
lower back or side pain
Less common
Blurred vision
dizziness
headache
loss of bladder control
nervousness
pounding in the ears
slow or fast heartbeat
Rare
Abdominal or stomach pain or tenderness
arm, back, or jaw pain
chest pain, tightness, heaviness, or discomfort
confusion
convulsions
decreased urine
difficult or troubled breathing
dilated neck veins
extreme fatigue
false beliefs that cannot be changed by facts
irregular breathing
irregular heartbeat
loss of consciousness
rapid breathing
seizures
severe nausea or vomiting
shortness of breath
sunken eyes
swelling of the face, fingers, feet, or lower legs
wrinkled skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Blurred vision
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
increasing muscle weakness
irregular, fast or slow, or shallow breathing
pale or blue lips, fingernails, or skin
slow or irregular heartbeat
sweating
unusual tiredness or weakness
watering of mouth
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
discouragement
fear
feeling of constant movement of self or surroundings
feeling sad or empty
irritability
lack of appetite
lack or loss of strength
loss of interest or pleasure
redness at the application site
sensation of spinning
stomach pain
tiredness
trouble concentrating
trouble sleeping
upper stomach pain
vomiting
Rare
Blindness
burning, stinging, or pain at application site
continuing ringing or buzzing or other unexplained noise in the ears
decreased vision
difficulty with moving
hearing loss
itchy skin
muscle pain or stiffness
pain in the joints
pale skin
tearing
troubled breathing with exertion
unusual bleeding or bruising
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Get your GoodRx coupon
$122.04
GoodRx discount
$21.23
Pros and cons of Rivastigmine
Pros
- A treatment option for dementia related to Alzheimer's or Parkinson's
- A pill that's taken by mouth
- Available in several strengths
Cons
- Taken twice per day with food
- Not available in a liquid form
- Can worsen the symptoms of other medical conditions (e.g., breathing problems, trouble urinating, stomach ulcers)
Pharmacist tips for Rivastigmine
- Take rivastigmine by mouth every day in the morning and in the evening, about 12 hours apart. Take the medication with food to help it get absorbed into your body better.
- Upset stomach is common with rivastigmine. Your care team can recommend some tips and tricks that you can try to help prevent or ease this side effect. But contact your prescriber if stomach upset gets too bothersome.
- Rivastigmine can make you tired, sleepy, dizzy, or confused. This can lower your ability to focus, think, and react. Avoid activities that need your full attention, such as driving a car or operating machinery, until you know how this medication affects you.
- Make sure to tell your care team about all of the medications you're taking. Don't start any new medications while you're taking rivastigmine without asking your care team first. They can check to make sure your medications are safe to take together. This is important because rivastigmine can have harmful interactions with a few medications, such as beta blockers and anticholinergic medications.
- If you forget to take rivastigmine for more than 3 days in a row, contact your prescriber about restarting the medication. They might recommend that you restart at a lower dose to avoid side effects.
Risks and warnings for Rivastigmine
Rivastigmine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Stomach upset and loss of appetite
- Risk factors: Taking higher doses of rivastigmine
Rivastigmine can cause many stomach-related side effects, such as nausea, vomiting, diarrhea, and a loss of appetite. Severe or long-lasting side effects could potentially lead to dehydration and some weight loss. Stomach-related side effects are more likely to happen if you take higher doses of rivastigmine or if your dose gets raised too quickly.
Always take rivastigmine exactly as prescribed. Call your prescriber if you miss more than 3 days of medication. You might need to restart at a lower dose to avoid these side effects.
Other side effects from rivastigmine
- Risk factors: Movement problems | Seizures | Stomach bleeding or peptic ulcers | Heart rate or heart rhythm problems | Problems with urination | Breathing problems
Rivastigmine raises the levels of acetylcholine in your body, which can affect other functions of the body and cause other side effects.
For example, rivastigmine can cause or worsen movement problems, including shaking (tremors). The medication can also cause you to have more stomach acid, putting you at risk for stomach ulcers and stomach bleeding. In addition, it can slow down your heart rate, which can put you at risk of fainting or falling. Rivastigmine can also worsen breathing problems in people with asthma or chronic obstructive pulmonary disease (COPD).
Make sure your care team knows about all of your medical conditions and medications you take. This will help your prescriber decide what rivastigmine dose is safe for you and how often you should follow up with them.
Rivastigmine dosage
The average cost for 1 carton of 30 patches of 4.6mg/24 hours of Rivastigmine is $51.59 with a free GoodRx coupon. This is 88.66% off the average retail price of $455.11. 
Capsule
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 4.5mg | 180 capsules | $49.68 | $0.28 |
| 6mg | 60 capsules | $21.47 | $0.36 |
| 3mg | 180 capsules | $44.19 | $0.25 |
| 1.5mg | 60 capsules | $21.23 | $0.35 |
Typical dosage for Rivastigmine
The typical starting dose is 1.5 mg by mouth twice a day with food. The maximum dose is 6 mg by mouth twice a day.
Your prescriber might adjust the dose depending on how well the medication is helping you and whether you're having bothersome side effects.
Interactions between Rivastigmine and other drugs
Rivastigmine may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Rivastigmine. Please note that only the generic name of each medication is listed below.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bromopride
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acebutolol
- Amifampridine
- Atenolol
- Betaxolol
- Bisoprolol
- Bupropion
- Carteolol
- Carvedilol
- Celiprolol
- Donepezil
- Esmolol
- Labetalol
- Levobunolol
- Metipranolol
- Metoclopramide
- Metoprolol
- Nadolol
- Nebivolol
- Oxprenolol
- Penbutolol
- Pindolol
- Practolol
- Propranolol
- Sotalol
- Timolol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Rivastigmine cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
Rivastigmine contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Rivastigmine will not be safe for you to take.
- Previous allergic skin reaction to rivastigmine patches
What are alternatives to Rivastigmine?
There are a number of medications that your doctor can prescribe in place of Rivastigmine. Compare a few possible alternatives below.
News about Rivastigmine
8 Rivastigmine (Exelon) Side Effects You Should Know About
Side effects of rivastigmine (Exelon) include headache, decreased appetite, nausea, and vomiting or diarrhea. Learn when to contact a healthcare provider about side effects.
Donepezil vs. Rivastigmine Patches for Alzheimer’s-Related Dementia
Donepezil and rivastigmine patches are in the same class of medications and have similar uses. However, there are a few differences to keep in mind.
Rivastigmine images
