Rivastigmine

Rivastigmine is used to treat dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and may cause changes in mood and personality) in people with Alzheimer's disease (a brain disease that slowly destroys the memory and ability to think, learn, communicate and handle daily activities). Rivastigmine is also used to treat dementia in people with Parkinson's disease (a brain and nervous system disease with symptoms of slowing of movement, muscle weakness, shuffling walk, and loss of memory). Rivastigmine is in a class of medications called cholinesterase inhibitors. It improves mental function (such as memory and thinking) by increasing the amount of a certain natural substance in the brain.

Rivastigmine comes as a capsule and solution (liquid) to take by mouth. It is usually taken twice a day with meals in the morning and evening. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any part you do not understand. Take rivastigmine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will start you on a low dose of rivastigmine and slowly increase your dose, not more than once every 2 weeks.

Rivastigmine may improve the ability to think and remember or slow the loss of these abilities but does not cure Alzheimer's disease or dementia in people with Parkinson's disease. Continue to take rivastigmine even if you feel well. Do not stop taking rivastigmine without talking to your doctor.

If you are taking rivastigmine oral solution, ask your pharmacist or doctor for a copy of the manufacturer's instructions for use. Carefully read these instructions. Always use the oral dosing syringe that comes with rivastigmine solution to measure your dose.Talk to your doctor or pharmacist if you have questions about how to measure your dose of rivastigmine solution.

Rivastigmine oral solution may be swallowed directly from the syringe or mixed with a liquid before use. Mix it with a small glass of water, cold fruit juice, or soda. Be sure to stir the mixture completely. Do not mix this medication with any liquid other than the ones listed. If the medication is mixed with water, juice, or soda, it must be taken within 4 hours.

To take a dose of rivastigmine solution, follow these steps:

1. Remove the oral dosing syringe that came with this medication from its protective case.
2. Push down and twist off the child-resistant cap to open the bottle of rivastigmine solution.
3. Put the tip of the oral syringe into the white stopper opening on top of the bottle.
4. While holding the syringe straight up, pull up on the plunger to the mark on the syringe that equals your dose.
5. Check the liquid in the syringe for air bubbles. If there are large air bubbles, gently move the syringe plunger up and down a few times. Do not worry about a few tiny air bubbles.
6. Make sure the plunger is on the mark on the syringe that equals your dose.
7. Remove the oral syringe from the bottle by pulling up on it.
8. Swallow your dose from the syringe directly, or mix it with the liquid you have chosen. Drink or swallow all of the solution.
9. Wipe off the outside of the oral syringe with a clean tissue, and put the syringe back into its case.
10. Close the child-resistant cap on the bottle of medication.

Rivastigmine is also used sometimes to treat Lewy body dementia (a condition in which the brain develops abnormal protein structures, and the brain and nervous system are destroyed over time). Talk to your doctor about the possible risks of using this medication for your condition.

Before taking rivastigmine,

• tell your doctor and pharmacist if you have ever had an allergic reaction to rivastigmine after taking the capsule or oral solution or using the skin patch, any other medications, or any of the ingredients in rivastigmine solution or capsules. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking rivastigmine. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you weigh less than 110 lb (50 kg), if you have or have ever had asthma, ulcers, abnormal heart beats, or other heart, liver, kidney, or lung disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking rivastigmine, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking rivastigmine.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

If you miss taking rivastigmine for more than a few days, talk to your doctor before starting to take it again. You will probably have to restart taking it at a lower dose.

Rivastigmine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• loss of appetite
• heartburn or indigestion
• stomach pain
• weight loss
• diarrhea
• constipation
• gas
• weakness
• dizziness
• headache
• extreme tiredness
• lack of energy
• tremor or worsening of tremor
• increased sweating
• difficulty falling asleep or staying asleep
• confusion

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• rash
• hives
• difficulty breathing or swallowing
• black and tarry stools
• red blood in stools
• bloody vomit
• vomiting material that looks like coffee grounds
• difficulty urinating
• painful urination
• seizures
• depression
• anxiety
• aggressive behavior
• hearing voices or seeing things that do not exist
• uncontrollable movements and muscle contractions

Rivastigmine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Store rivastigmine solution in an upright position. Do not place rivastigmine solution in the freezer or allow rivastigmine solution to freeze.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. https://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• nausea
• vomiting
• increased saliva
• sweating
• slow heart beat
• inability to hold urine
• slowed thinking and movement
• dizziness
• fainting
• blurred vision
• difficulty breathing
• loss of consciousness
• seizure

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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