Rivastigmine (brand name Exelon) is a cholinesterase inhibitor used mainly to treat symptoms of mild to moderate Alzheimer’s disease and Parkinson’s-related dementia. It won't cure dementia, but it can help with memory, thinking, and daily tasks for some people. Expect small-to-moderate benefits, usually measured over months, and varying results between patients.
Rivastigmine boosts levels of acetylcholine, a brain chemical involved in memory and thinking. The drug comes as capsules, an oral solution, and a transdermal patch. The patch often causes fewer stomach problems because it delivers the medicine steadily through the skin. Capsules and solution are taken twice daily and act faster in blood levels, which sometimes means more nausea.
Typical oral start: 1.5 mg twice daily for at least two weeks, then increase to 3 mg twice daily as tolerated. Many patients reach 6 mg twice daily if they tolerate it. Patch dosing usually starts at 4.6 mg/24h, then moves to 9.5 mg/24h and sometimes 13.3 mg/24h. Follow your doctor’s schedule — don’t jump doses on your own.
Common side effects include nausea, vomiting, diarrhea, decreased appetite, weight loss, dizziness, and headache. Patches can cause skin irritation at the application site; rotate sites and check skin daily. Less common but serious issues are slow heart rate (bradycardia), fainting, and increased sweating. If you notice fainting, very slow pulse, or sudden weight loss, contact your clinician right away.
To reduce nausea, take oral doses with food and increase dose slowly. If the patch irritates skin, remove it and tell the prescriber; they may switch delivery methods or try a different site. If a dose is missed, take it as soon as remembered that day; skip if it’s near the next dose. Do not double up.
Rivastigmine interacts with drugs that affect heart rhythm and with anticholinergic drugs (like some antihistamines, bladder meds and older sleep medicines). Anticholinergics can cancel out rivastigmine’s effect. Tell your doctor about all prescriptions, over-the-counter meds and supplements.
Patients with severe liver or kidney disease may need dose changes. Older adults often tolerate lower doses better. Your prescriber may monitor weight, heart rate, blood pressure, and for signs of stomach bleeding or dehydration during the first weeks.
What should you expect? If rivastigmine helps, you may see steadier thinking or better daily function for months. If there’s no clear benefit after a trial period, your clinician may stop it. Always weigh side effects against any benefits — and ask for a clear plan: target dose, how long to try it, and when to reassess.
If you have questions about rivastigmine or symptom changes, bring specific examples to appointments: changes in eating, sleep, balance, or mood. Those details make decisions easier for you and your care team.
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