Formulary
Rivastigmine: Indications, Dosing, Side Effects and Interactions
Rivastigmine is a reversible non-competitive inhibitor of acetylcholinesterases.
MedNext Academy | 3 min read
Rivastigmine: Indications, Dosing, Side Effects and Interactions
Rivastigmine is a reversible non-competitive inhibitor of acetylcholinesterases.
Drug action
Rivastigmine is a reversible non-competitive inhibitor of acetylcholinesterases.
Indications and dose
**Mild to moderate dementia in Alzheimer's disease**
- **Adult** (By Transdermal Application Using Patches): Apply 4.6 mg/24 hours twice weekly for at least 4 weeks, increased if tolerated to 9.5 mg/24 hours twice weekly, if further dose increases are necessary after 6 months of treatment with the 9.5 mg/24 hours twice weekly patch, switch to a higher strength daily patch. If treatment interrupted for more than 3 days, retitrate from 4.6 mg/24 hours twice weekly patch.
**Mild to moderate dementia in Parkinson's disease**
- **Adult** (By Mouth): Initially 1.5 mg twice daily, increased in steps of 1.5 mg twice daily, dose to be increased at intervals of at least 2 weeks according to response and tolerance; usual dose 3-6 mg twice daily (max. per dose 6 mg twice daily), if treatment interrupted for more than several days, retitrate from 1.5 mg twice daily.
Cautions
Bladder outflow obstruction; conduction abnormalities; duodenal ulcers; gastric ulcers; history of asthma; history of chronic obstructive pulmonary disease; history of seizures; patients at risk of developing torsade de pointes; risk of fatal overdose with patch administration errors; sick sinus syndrome; susceptibility to ulcers Cautions, further information Elderly For acetylcholinesterase inhibitors, Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate in patients with a known history of persistent bradycardia (heart rate less than 60 beats per minute), heart block, recurrent unexplained syncope, or concurrent treatment with drugs that reduce heart rate (risk of cardiac conduction failure, syncope, and injury).
Side effects
General side-effects: Common or very common Anxiety; appetite decreased; arrhythmias; asthenia; dehydration; depression; diarrhoea; dizziness; drowsiness; fall; gastrointestinal discomfort; headache; hypertension; movement disorders; nausea; skin reactions; syncope; tremor; urinary incontinence; urinary tract infection; vomiting; weight decreased Uncommon Aggression; atrioventricular block Rare or very rare Pancreatitis; seizure Frequency not known Hepatitis Specific side-effects: Common or very common With oral use Confusion; gait abnormal; hallucinations; hyperhidrosis; hypersalivation; malaise; parkinsonism; sleep disorders With transdermal use Delirium; fever Uncommon With oral use Hypotension With transdermal use Gastric ulcer Rare or very rare With oral use Angina pectoris; gastrointestinal disorders; gastrointestinal haemorrhage Frequency not known With transdermal use Hallucination; nightmare Side-effects, further information Treatment should be interrupted if dehydration resulting from prolonged vomiting or diarrhoea occurs and withheld until resolution-retitrate dose if necessary. Transdermal administration is less likely to cause side-effects.
Interactions
**Other interactions (12):**
- No specific interaction studies have been performed with rivastigmine transdermal patches.
- As a cholinesterase inhibitor, rivastigmine may exaggerate the effects of succinylcholine-type muscle relaxants during anaesthesia.
- In view of its pharmacodynamic effects and possible additive effects, rivastigmine should not be given concomitantly with other cholinomimetic substances.
- Rivastigmine might interfere with the activity of anticholinergic medicinal products (e.g.
- Additive effects leading to bradycardia (which may result in syncope) have been reported with the combined use of various beta-blockers (including atenolol) and rivastigmine.
- Cardiovascular beta- blockers are expected to be associated with the greatest risk, but reports have also been received in patients using other beta-blockers.
Hepatic impairment
Manufacturer advises caution (risk of increased exposure; no information available in severe impairment). Dose adjustments Manufacturer advises cautious dose titration according to individual tolerability.
Renal impairment
Dose adjustments With oral use: Titrate according to individual tolerability (risk of increased exposure). M
Medicinal forms
Capsule,Solution,Patch
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Rivastigmine in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary

