rivastigmine hydrogen tartrate: clinical use

Prescribing considerations

• Initiation and supervision should involve a clinician experienced in diagnosing and treating Alzheimer’s or Parkinson’s disease dementia.
• Confirm that a caregiver can monitor administration and tolerability.
• Reassess clinical benefit regularly and review adherence, adverse effects and ongoing treatment goals.
• Adverse effects are more likely in people with low body weight or clinically significant renal or hepatic impairment.
• After a treatment interruption exceeding three days, arrange supervised reintroduction rather than resuming unsupervised.

Contraindications and cautions

• Hypersensitivity to rivastigmine, another carbamate derivative or a product excipient
• Previous rivastigmine-patch reaction suggestive of allergic contact dermatitis

Monitoring

• Before treatment: pulse, body weight, electrolytes, renal function and liver function
• Consider an ECG when QT prolongation, bradyarrhythmia or other cardiac risk factors are present
• During treatment: pulse, weight, gastrointestinal tolerance, hydration, syncope or falls, and cognitive or functional benefit
• In Parkinson’s disease dementia: monitor tremor and other extrapyramidal symptoms

Clinical pharmacology

Rivastigmine is a carbamate inhibitor of acetyl- and butyrylcholinesterase. It crosses the blood–brain barrier, is rapidly hydrolysed mainly by cholinesterases, has little CYP-mediated metabolism and is eliminated predominantly as urinary metabolites.

Formulation and product differences

• Hard capsules must be swallowed whole.
• Oral solution is measured using the supplied syringe and may be taken directly or in a small glass of water.
• The oral solution contains sodium benzoate and is essentially sodium-free.
• The selected capsule contains colouring agents that may cause allergic reactions.

Capsule

Route: Oral

Strengths: 1.5 mg, 3 mg, 4.5 mg, 6 mg

Oral solution

Route: Oral

Strengths: 2 mg/mL