Rivastigmine | Side Effects, Dosage, Uses & More
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Generic Name:

rivastigmine, Oral capsule

All Brands

  • Exelon
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Highlights for rivastigmine

Oral capsule
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Rivastigmine is used to treat dementia caused by Alzheimer’s disease and Parkinson’s disease.

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Your dose depends on the condition that you’re treating, form of the drug that you’re taking, and other health problems you have. Your doctor will decide a dose that’s right for you.

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This drug may cause a serious skin reaction. Symptoms of this skin reaction include: itching, redness, swelling, warmth, tenderness, peeling, or blistering of your skin. You may need to stop taking rivastigmine if this happens.

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Rivastigmine may increase the acid in your stomach. This can cause severe stomach problems, including bleeding in your stomach (ulcers).

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Common side effects include stomach problems, depression, anxiety, trouble sleeping, muscle weakness, headache, dizziness, and urinary tract infections.

IMPORTANT INFORMATION

Stomach problems

Rivastigmine may increase the acid in your stomach. This can cause severe stomach problems, including bleeding in your stomach (ulcers). If this happens, your doctor may tell you to stop taking this drug.

Skin reactions

This drug may cause a serious skin reaction called allergic dermatitis. Symptoms include skin:

  • itching
  • redness
  • swelling
  • warmth
  • tenderness
  • peeling
  • blistering

If you have these symptoms, your doctor may tell you to stop taking rivastigmine.

Drug features

Rivastigmine is a prescription drug. It’s available in these forms: oral capsule, oral solution, and topical patch.

Rivastigmine is available as a generic drug. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

Rivastigmine may be used as part of a combination therapy. That means you need to take it with other drugs.

Why it's used

Rivastigmine is used to treat:

  • mild, moderate, and severe dementia caused by Alzheimer’s disease
  • mild to moderate memory dementia caused by Parkinson’s disease

More Details

How it works

Rivastigmine belongs to a class of drugs called cholinesterase inhibitors. A class of drugs refers to medications that work similarly. They have similar chemical structure and are often used to treat similar conditions.

Rivastigmine increases the amount of certain substances in your brain that may improve your memory and thinking.

Why it's used

Rivastigmine is used to treat:

  • mild, moderate, and severe dementia caused by Alzheimer’s disease
  • mild to moderate memory dementia caused by Parkinson’s disease

When you have dementia, your mental function may be getting worse. You may have memory loss, confusion, and other thinking or behavior problems. These issues may affect your ability to do daily tasks.

Rivastigmine doesn’t cure Alzheimer’s disease. All people with this condition get worse over time.

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rivastigmine Side Effects

Oral capsule

Most Common Side Effects

The most common side effects that occur with rivastigmine include:

  • stomach problems, such as:

    • stomach pain
    • nausea
    • diarrhea
    • vomiting
    • heartburn
  • anxiety

  • depression

  • trouble sleeping

  • headache

  • dizziness

  • tiredness

  • urinary tract infections

  • muscle weakness

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening or if you think you’re experiencing a medical emergency, call 9-1-1.

  • stomach problems. Symptoms include:

    • bleeding in your stomach (ulcers)
  • skin problems. Symptoms include:

    • itching
    • redness
    • swelling
    • warmth
    • tenderness of the skin
    • peeling or blistering of the skin that may ooze, drain, or crust over
  • heart problems. Symptoms include:

    • slow heart rate (bradycardia)
    • fainting
  • seizures

  • problems with movement (tremors)

Pharmacist's Advice
Healthline Pharmacist Editorial Team

Rivastigmine doesn’t cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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rivastigmine May Interact with Other Medications

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Rivastigmine can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Medications that might interact with this drug

Anesthesia medications

Using rivastigmine with certain anesthesia medications may make your muscles relax too much during surgery.

Dementia medications

These drugs work similarly to rivastigmine. Your risk of side effects may be higher if you take these drugs together.

These drugs include:

  • tacrine
  • galantamine
  • donepezil

High blood pressure drugs

These drugs may slow down your heart rate too much when used with rivastigmine.

These drugs include:

  • atenolol
  • metoprolol
  • propranolol
  • acebutolol

Overactive bladder drugs

These drugs may not work as well when taken with rivastigmine.

These drugs include:

  • oxybutynin
  • tolterodine

Stomach problems drugs

These medicines increase your risk of tremors when used with rivastigmine.

These drugs include:

  • metoclopramide

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with neurological problems

Rivastigmine may increase your risk of tremors or seizures.

People with heart problems

Rivastigmine may cause your heart rate to slow down too much.

People with urination problems

If you have problems urinating, rivastigmine many make your condition worse. This drug may make it harder for your bladder muscles to contract.

People with breathing problems

Use this drug with caution if you have a history of asthma or obstructive pulmonary disease.

People with ulcers

This drug can increase your stomach acid. This raises your risk of stomach bleeding or ulcers. Tell your doctor if you have a history of ulcers or take drugs like aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). You may have a higher risk for ulcers.

Pregnant women

Rivastigmine is a pregnancy category B drug. That means two things:

  1. Research in animals hasn’t shown a risk to the fetus when the mother takes the drug.
  2. There aren’t enough studies done in humans to show if the drug poses a risk to the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. Animal studies don’t always predict the way humans would respond. Therefore, this drug should only be used in pregnancy if clearly needed.

Women who are breast-feeding

It isn’t known if rivastigmine passes into breast milk. If it does, it may cause side effects in a child who is breast-fed.

Talk to your doctor if you breast-feed your baby. You may need to decide whether to stop breast-feeding or stop taking this medication.

For children

The safety and effectiveness of rivastigmine in people under 18 years of age haven’t been established.

Allergies

Rivastigmine may cause a severe allergic reaction. Symptoms include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives
  • severe skin reactions

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take rivastigmine (Dosage)

Oral capsule

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Dementia caused by Alzheimer’s disease

Brand: Exelon

Form: Oral capsule
Strengths: 1.5 mg, 3 mg, 4.5 mg, 6 mg

Generic: rivastigmine

Form: Oral capsule
Strengths: 1.5 mg, 3 mg, 4.5 mg, 6 mg
Adult dosage (ages 18 years and older)
  • starting dose: 1.5 mg taken by mouth two times per day
  • dose changes:
    • After 2 weeks, your doctor may increase your dose to 3 mg taken twice per day.
    • Your doctor may increase your dose every 2 weeks up to a maximum dose of 6 mg taken twice per day.
  • Interruption of treatment:
    • If you have serious side effects, your doctor may have you temporarily stop taking the medication.
    • If you don’t take the drug for up to 3 days, you should start taking it again at the same or lower dose.
    • If you don’t take the medication for more than 3 days, you should start taking it again at 1.5 mg taken two times per day.
Child dosage (ages 0–17 years)

The safety and effectiveness of rivastigmine in people under 18 years of age haven’t been established.

Special considerations

Kidney problems: If you have moderate or severe kidney disease, you may have a greater risk of side effects. Your doctor may give you a lower dose.

Liver problems: If you have mild or moderate liver disease, you may have a greater risk of side effects. Your doctor may give you a lower dose.

Low body weight: Your doctor should carefully increase your dose if you weigh less than 110 lbs. (50 kg). People with low body weight may have a higher risk of side effects, such as nausea and vomiting.

Parkinson’s disease dementia

Brand: Exelon

Form: Oral capsule
Strengths: 1.5 mg, 3 mg, 4.5 mg, 6 mg

Generic: rivastigmine

Form: Oral capsule
Strengths: 1.5 mg, 3 mg, 4.5 mg, 6 mg
Adult dosage (ages 18 years and older)
  • starting dose: 1.5 mg taken twice per day
  • dose changes:
    • After 4 weeks, your doctor may increase your dose to 3 mg taken twice per day.
    • Your doctor may increase your dose every 4 weeks up to a maximum dose of 6 mg taken twice per day.
  • Interruption of treatment:
    • If you have serious side effects, your doctor may have you temporarily stop taking the medication.
    • If you don’t take the drug for up to 3 days, you should start taking it again at the same or lower dose.
    • If you don’t take the medication for more than 3 days, you should start taking it again at 1.5 mg taken two times per day.
Child dosage (ages 0–17 years)

The safety and effectiveness of rivastigmine in people under 18 years of age haven’t been established.

Special considerations

Kidney problems: If you have moderate or severe kidney disease, you may have a greater risk of side effects. Your doctor may give you a lower dose.

Liver problems: If you have mild or moderate liver disease, you may have a greater risk of side effects. Your doctor may give you a lower dose.

Low body weight: Your doctor should carefully increase your dose if you weigh less than 110 lbs. (50 kg). People with low body weight may have a higher risk of side effects, such as nausea and vomiting.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Rivastigmine comes with serious risks if you don’t take it as prescribed.

If you don't take it at all

If you don’t take it at all, your memory problems, confusion, and other thinking or behavior problems may get worse.

If you skip or miss doses

If you skip or miss doses, this medicine may not work as well.

If you take too much

If you take too much of this medication, you may have more side effects. These include:

  • severe nausea and vomiting
  • changes in your blood pressure
  • sweating
  • drooling
  • trouble breathing
  • seizures
  • hallucinations
  • tremors

If you think you’ve taken too much of the drug, act right away. Call your doctor or local Poison Control Center, or go to the nearest emergency room.

What to do if you miss a dose

If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, then wait and only take one dose at that time.

Never try to catch up by taking two doses at once. This could cause toxic side effects.

How to tell if the drug is working

If this drug is working your memory may get better and you may have an easier time doing daily tasks.

Rivastigmine is used for long-term treatment.

Important considerations for taking rivastigmine
take with meals Rivastigmine should be taken with meals
timing Rivastigmine should be taken in the morning and the evening
storage This drug must be stored at the right temperature See Details
refillable Prescription is refillable
travel Travel See Details
Clinical monitoring Clinical monitoring See Details
not usually stocked Not every pharmacy stocks this drug, so call ahead
hidden costs Hidden costs See Details
Insurance Insurance See Details

This drug must be stored at the right temperature

  • Store it as close to 77°F (25°C) as possible.
  • It can be stored from 59–86°F (15–30°C) for short periods of time.
  • Keep this drug away from light and high temperatures.
  • Keep your drugs away from areas where they could get wet, such as bathrooms. Store this drug away from moisture and damp locations.

Travel

When traveling with your medication:

  • Always carry your medication with you, such as in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Before starting and during treatment with rivastigmine, your doctor may monitor the following:

  • upper endoscopy. This test looks at the lining of your upper digestive tract. You may have this test if your doctor thinks you have an ulcer.
  • changes in weight. Your doctor should check your weight. Changes in weight can increase or decrease the level of the drug in your body.

Hidden costs

You may need to pay for an upper endoscopy and/or allergy testing if you have side effects from this drug.

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for rivastigmine.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

What does the pill look like?

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How Much Does rivastigmine Cost?

Oral capsule

We've partnered with GoodRx so you can compare prices, find discounts and save up to 80% on your next prescription. Check out the low coupon prices below — no insurance required.

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Lowest price for rivastigmine

Walmart $95.54
Sams Club $95.54
Walgreens $102.37
These prices represent the lowest priced national pharmacies for rivastigmine on GoodRx. They may be lower than your insurance.

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These prices represent the lowest priced national pharmacies for rivastigmine on GoodRx. They may be lower than your insurance.

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on September 3, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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