Rivastigmine

About Rivastigmine

Rivastigmine slows the breakdown of acetylcholine, a brain chemical involved in memory and thinking; it treats symptoms and does not cure the disease. Capsules are labeled for mild to moderate Alzheimer’s dementia and mild to moderate Parkinson’s disease dementia; the patch also covers severe Alzheimer’s dementia. Capsules start at 1.5 mg twice a day with meals and are raised no faster than every two weeks; the patch starts at 4.6 mg per 24 hours and is raised after at least four weeks.

Nausea, vomiting, loss of appetite, indigestion, weakness and dizziness are the common side effects, and weight loss is a recognized effect worth reporting. If treatment is interrupted for more than three days it is restarted at the lowest dose, because going straight back to a higher dose can cause severe vomiting. It can also slow the heart and cause fainting, worsen stomach ulcers, provoke seizures, make it harder to pass urine, and aggravate asthma or other lung disease.

The patch has two warnings of its own: wearing more than one at a time, or forgetting to remove the old one, has caused overdoses needing hospital care and, rarely, death. Mild redness at the site is common, but a reaction that spreads beyond the patch or does not improve within 48 hours of removal suggests allergic contact dermatitis; the patch is then stopped, and capsules can follow only after allergy testing.

Taking Rivastigmine

How to take it

Capsules: twice a day with breakfast and the evening meal. Patch: once a day on clean, dry, hairless skin of the back, upper arm or chest, with no lotion underneath; press it on firmly, take it off after 24 hours, and put the new one on a different spot, not reusing a spot for at least fourteen days. Wash your hands afterward, keep it away from heating pads and saunas, and fold used patches sticky sides together before discarding them.

If you miss a dose

Capsules: take it when you remember unless the next dose is near, then skip it. Patch: apply it as soon as you remember and remove it at the usual time. After three or more days missed with either form, call the prescriber before restarting.

Storage

At room temperature, tightly closed, away from heat and moisture, patches sealed in their pouches until use, out of reach of children and pets.

Interactions to know about

Anticholinergic medicines such as oxybutynin and antihistamines like diphenhydramine work against it; metoclopramide, beta blockers and other cholinergic medicines are not recommended with it. Aspirin, ibuprofen and naproxen add to the risk of stomach bleeding, and the anesthetist should know about it before surgery.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Rivastigmine differs from pharmacy to pharmacy

Generic capsules have many makers and cost pharmacies little, so a month of capsules is priced mostly on the dispensing fee. The patch costs pharmacies far more, fewer companies make it, and a pharmacy may stock only some strengths, so quotes differ widely; a prescription that names Exelon Patch and blocks substitution is quoted at a brand price.

Ways to pay less for Rivastigmine without insurance

• Ask the prescriber whether capsules would suit you, since they cost far less than the patch.
• If the patch is prescribed, ask for generic substitution and compare more than one pharmacy.
• Ask for a ninety-day supply once the dose has been stable.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Rivastigmine

1. 1.Where do I apply the patch, and how do I rotate the sites?
2. 2.What should I do if a patch falls off, or if we miss more than three days?
3. 3.Which allergy, bladder or stomach medicines interact with it?
4. 4.What skin reaction means the patch should be stopped?

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