Rivastigmine Transdermal Patch

Rivastigmine transdermal patches are used to treat dementia (a brain disorder that affects memory, thinking, and behavior ) in people with Alzheimer's disease (AD; a brain disease that affects memory, thinking, and behavior) or in people with Parkinson's disease (PD; a disorder of the nervous system that causes difficulties with movement, muscle control, and balance.). Rivastigmine is in a class of medications called cholinesterase inhibitors. It works by increasing the amount of a certain naturally occurring substance in the brain.

Transdermal rivastigmine comes as a patch you apply to the skin. It is applied once a day, at around the same time each day. Remove the old patch before placing a new patch.

Your doctor will probably start you on a low dose of transdermal rivastigmine and gradually increase your dose, not more often than once every 4 weeks.

Transdermal rivastigmine controls the symptoms of dementia but does not cure it. Continue to use transdermal rivastigmine even if you feel well. Do not stop using transdermal rivastigmine without talking to your doctor.

Apply the patch to clean, dry skin that is relatively free of hair (upper or lower back or upper arm or chest). Do not apply the patch to an open wound or cut, to skin that is irritated, red, or to skin that is affected by a rash or other skin problem. Do not apply the patch to a place that would be rubbed against by tight clothing. Select a different area each day to avoid skin irritation. Be sure to remove the patch before you apply another one. Do not apply a patch to the same spot for at least 14 days.

To apply the patch, follow these steps:

1. Choose the area where you will apply the patch. Wash the area with soap and warm water. Rinse off all of the soap and dry the area with a clean towel. Be sure the skin is free of powders, oil, and lotions.
2. Select a patch in a sealed pouch and cut open the pouch open with scissors. Be careful not to cut the patch.
3. Remove the patch from the pouch and hold it with the protective liner facing you.
4. Peel the liner off one side of the patch. Be careful not to touch the sticky side with your fingers. A second strip of liner should remain stuck to the patch.
5. Press the patch firmly onto your skin with the sticky side down.
6. Remove the second strip of protective liner and press the rest of the sticky side of the patch firmly against your skin. Be sure that the patch is pressed flat against the skin with no bumps or folds and the edges are firmly attached to the skin.
7. Wash your hands with soap and water after you handle the patch.
8. After you have worn the patch for 24 hours, use your fingers to peel the patch off slowly and gently. Fold the patch in half with the sticky sides together and dispose of it safely, out of reach of children and pets.
9. Apply a new patch to a different area immediately by following steps 1 to 8.

While you are wearing a rivastigmine patch, protect the patch from direct heat such as heating pads, electric blankets, heat lamps, saunas, hot tubs, and heated water beds. Do not expose the patch to direct sunlight for very long.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using transdermal rivastigmine,

• tell your doctor or pharmacist if you are allergic to this medication, carbamate derivatives, any part of this medication, or any other medications, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
• you should know that some medications should not be taken with transdermal rivastigmine. Other medications may cause dosing changes or extra monitoring when taken with transdermal rivastigmine. Make sure you have discussed any medications you are currently taking or plan to take before starting transdermal rivastigmine with your doctor and pharmacist. Before starting, stopping, or changing any medications while taking transdermal rivastigmine, please get the advice of your doctor or pharmacist.
• you should know the following nonprescription or herbal products may interact with transdermal rivastigmine: aspirin, ibuprofen, naproxen, diphenhydramine, brompheniramine, chlorpheniramine, doxylamine, dimenhydrinate, meclizine, loperamide. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking transdermal rivastigmine. Do not start any of these medications while taking transdermal rivastigmine without discussing with your healthcare provider.
• tell your doctor if you have or have ever had bleeding in your stomach or intestines; an ulcer; heart problems or an irregular, slow, or fast heartbeat, seizures; difficulty urinating; asthma or breathing problems; or kidney or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using transdermal rivastigmine, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using transdermal rivastigmine.

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

Apply the missed patch as soon as you remember it. However, you should still remove the patch at your regular patch removal time. If it is almost time for the next patch, skip the missed patch and continue your regular dosing schedule. Do not apply extra patches to make up for a missed dose. If you do not use transdermal rivastigmine for 3 days or longer, you should call your doctor before start using this medication again.

If the patch loosens or falls off, replace it with a new patch. However, you should remove the new patch at the time that you were scheduled to remove the original patch.

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

• nausea, vomiting, diarrhea, loss of appetite, stomach pain, weight loss
• depression, anxiety
• headache
• dizziness
• weakness
• excessive tiredness, difficulty falling asleep or staying asleep
• tremor or worsening tremor

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:  

• black and tarry stools, red blood in stools, bloody vomit, vomiting material that looks like coffee grounds
• difficulty urinating, painful urination
• seizures
• skin reactions that spread beyond the patch including, itching, redness, swelling, warmth, tenderness, peeling or blistering that may ooze, drain, or crust over
• fainting, slow heartbeat, chest pain
• new or worsening breathing problems

Transdermal 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). Dispose of any patches that are outdated or no longer needed by opening each pouch, folding each patch in half with the sticky sides together. Place the folded patch in the original pouch and dispose of it safely, out of the reach of children and pets.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website https://goo.gl/c4Rm4p for more information.

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:

• nausea, vomiting, diarrhea
• increased saliva
• sweating
• slow heartbeat
• dizziness
• muscle weakness
• difficulty breathing
• fainting
• seizures

If someone applies extra or a higher dosage of transdermal rivastigmine but does not have any of the symptoms listed, remove the patch or patches. Call your doctor and do not apply any additional patches for the next 24 hours.

Keep all appointments with your doctor.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

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