-5%
Rivastigmine is a carbamate derivative structurally related to physostigmine. It acts as a reversible cholinesterase inhibitor by inactivating enzymes such as acetylcholinesterase and butyrylcholinesterase.
This action prevents the breakdown of acetylcholine, resulting in increased levels of acetylcholine at cholinergic synapses in the brain. Rivastigmine shows greater selectivity for brain cholinesterase enzymes compared to those in peripheral tissues, which may help improve cognitive function in dementia patients.
RivaCap Capsule is indicated for the symptomatic treatment of:
- Mild to moderately severe Alzheimer’s dementia
- Mild to moderately severe dementia associated with Idiopathic Parkinson’s disease
Rivastigmine Capsule
The capsules should be taken twice daily with morning and evening meals.
Initial Dose
- 1.5 mg twice daily
Dose Titration
- If well tolerated after at least 2 weeks, increase to 3 mg twice daily
- Further increases to 4.5 mg and then 6 mg twice daily may be considered after a minimum of 2 weeks at each dose level
Maintenance Dose
- Effective dose range: 3 mg to 6 mg twice daily
- Maximum recommended dose: 6 mg twice daily
Treatment may continue as long as clinical benefit is maintained.
Re-initiation of Therapy
If treatment is interrupted for more than several days, restart at 1.5 mg twice daily and retitrate gradually.
Rivastigmine Transdermal Patch
Initial Dose
- 4.6 mg/24 hours patch once daily
Dose Escalation
- After at least 4 weeks, increase to 9.5 mg/24 hours if tolerated
- After another minimum 4 weeks, may increase to 13.3 mg/24 hours
Recommended Maintenance Doses
- Mild to moderate Alzheimer’s disease and Parkinson’s disease dementia: 9.5 mg/24 hr or 13.3 mg/24 hr
- Severe Alzheimer’s disease: 13.3 mg/24 hr
Apply one patch daily on intact skin and replace every 24 hours.
রেজিস্টার্ড চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন।
Administration
- Apply only one patch at a time
- Replace the old patch with a new one every 24 hours
- Your doctor may adjust the dose according to individual response and tolerability
Drug Interactions
- May enhance the effects of succinylcholine-type muscle relaxants during anesthesia
- Concomitant use with other cholinomimetic agents is not recommended
- May interfere with anticholinergic medications
- No significant pharmacokinetic interactions have been observed with digoxin, warfarin, diazepam, or fluoxetine
Contraindications
RivaCap is contraindicated in patients with:
- Hypersensitivity to rivastigmine
- Allergy to carbamate derivatives
Side Effects
Common Adverse Effects
- Nausea
- Vomiting
- Diarrhea
- Weight loss
- Loss of appetite
Female patients may be more susceptible to gastrointestinal side effects and weight reduction.
Pregnancy & Lactation
Pregnancy
There are insufficient clinical data regarding use during pregnancy. Rivastigmine should only be used if clearly necessary.
Lactation
Animal studies show excretion into milk. Since it is unknown whether rivastigmine passes into human breast milk, breastfeeding is not recommended during therapy.
Precautions & Warnings
Use cautiously in patients with:
- Sick sinus syndrome or cardiac conduction disorders
- Asthma or chronic obstructive pulmonary disease
- Renal impairment
- Mild to moderate hepatic impairment
- History of seizures
- Urinary obstruction
- Gastric ulcer risk due to increased gastric acid secretion
Rivastigmine may worsen extrapyramidal symptoms in Parkinson’s disease patients. Regular monitoring of body weight is recommended.
Use in Special Populations
Renal & Hepatic Impairment
Patients with moderate renal impairment or mild-to-moderate hepatic impairment may require careful dose titration based on tolerability.
Pediatric Use
RivaCap is not recommended for use in children.
Overdose Effects
Symptoms of overdose may include:
- Nausea
- Vomiting
- Diarrhea
- Hallucinations
- Hypertension
- Bradycardia or fainting
Most overdose cases resolve with supportive care. In severe cases, atropine sulfate may be used as an antidote under medical supervision.
Therapeutic Class
Drugs for Dementia
Storage Conditions
Store in a cool and dry place, protected from light and moisture. Keep out of the reach of children.