rivastigmine at a glance
Medicine class
Acetylcholinesterase and butyrylcholinesterase inhibitor
Licensed patch use
Symptomatic treatment of mild to moderately severe Alzheimer’s dementia
Essential patch check
Remove the old patch before applying a new one, and never wear multiple patches.
What is rivastigmine used for?
The selected transdermal product has one UK-licensed indication. Other uses require formulation-specific and specialist assessment.
Licensed: symptomatic treatment of mild to moderately severe Alzheimer’s dementia.
Rivastigmine is sometimes used by specialists for dementia with Lewy bodies, where it may help hallucinations, confusion or sleepiness.
How does rivastigmine work?
Rivastigmine temporarily inhibits acetylcholinesterase and butyrylcholinesterase, slowing the breakdown of acetylcholine released by functioning nerve cells. This can strengthen cholinergic communication and reduce some cognitive or behavioural symptoms, without reversing the underlying neurodegeneration.
rivastigmine preparations and strengths
Transdermal patch
Route: Transdermal
Strengths: 4.6 mg/24 hours, 9.5 mg/24 hours, 13.3 mg/24 hours
How to take rivastigmine
Use the patch exactly as prescribed. A caregiver may help with application and monitoring where needed.
Remove any existing patch before applying a new one; only one patch should be worn at a time.
Apply to clean, dry, hairless, unbroken skin on the upper or lower back, upper arm or chest. Avoid creams, lotions and powders at the site.
Use a different skin location and do not reuse the exact site within 14 days.
Press the patch firmly with the palm, do not cut it, and avoid prolonged external heat such as saunas or strong direct heat.
Bathing, showering and swimming should not normally affect a securely attached patch. Wash hands after handling a used patch.
rivastigmine side effects
Common or expected effects
- Redness, itching, irritation or swelling where the patch is applied
- Nausea, vomiting, diarrhoea, indigestion or abdominal pain
- Reduced appetite or weight loss
- Headache, dizziness or fainting
- Tiredness, agitation, anxiety or depression
- Urinary incontinence
Get urgent medical advice
- Slow, fast or irregular heartbeat, fainting or collapse
- Persistent vomiting or diarrhoea causing dehydration
- A skin reaction spreading beyond the patch, blistering or failing to improve after removal
- Seizure or marked worsening of tremor, stiffness or other Parkinsonian symptoms
- Severe upper-abdominal pain, gastrointestinal bleeding or jaundice
- Breathing difficulty, profound weakness or other suspected overdose symptoms
rivastigmine in pregnancy
Human pregnancy data are lacking. Rivastigmine should not be used during pregnancy unless a specialist or prescriber judges it clearly necessary after considering potential benefits and risks.
rivastigmine while breastfeeding
It is unknown whether rivastigmine enters human milk, although it is present in animal milk. The product information advises against breastfeeding during treatment; discuss alternatives with the specialist or prescriber.
rivastigmine interactions
Review all prescribed, non-prescribed and herbal products. Important pharmacodynamic interactions include:
Beta-blockers and other heart-rate-lowering medicines
Effects may combine to cause bradycardia, fainting or loss of consciousness.
Medicines that prolong the QT interval
The combination may increase arrhythmia risk; ECG monitoring may be appropriate in susceptible patients.
Anticholinergic medicines such as oxybutynin or tolterodine
Rivastigmine may oppose their intended anticholinergic effects.
Common questions about rivastigmine
Answers are fully visible for fast scanning and source review.
Can rivastigmine cure Alzheimer’s disease?
No. It may temporarily reduce some symptoms, but it does not cure dementia or stop the underlying disease from progressing.
Why does rivastigmine treatment often involve a caregiver?
Dementia can make consistent and safe patch use difficult. A caregiver can check that the old patch is removed, only one patch is used and treatment is monitored.
Where can a rivastigmine patch be applied?
Apply it to clean, dry, hairless, healthy skin on the upper or lower back, upper arm or chest, where tight clothing will not rub it.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.