What is this medication for?

Rivastigmine belongs to a class of medications known as acetylcholinesterase inhibitors. It is used to reduce symptoms of mild to moderately severe Alzheimer’s disease, Parkinson’s dementia, or other types of dementia, such as:

• Difficulty in remembering recent events, activities, or the names of familiar people or things
  

• Poor concentration and judgement
  

It will not cure or stop the dementia from getting worse, but it may improve the ability to think in some patients and slow down the worsening of these symptoms.

Check with your healthcare professional if you are unsure why you are given this medication.

How should I take/use this medication?

• Follow the instructions on your medication label and take this medication as prescribed by your doctor. Rivastigmine is available as oral capsules and skin patches.

For Rivastigmine capsules:

• It should be taken with or after food and be swallowed whole.

For Rivastigmine patches:

• To use the patches:
• Remove any old patch first before applying a new one.
  

• Before applying the patch, make sure that your skin is clean, dry and hairless, free of any powder, oil, moisturizer or lotion.
  

• Apply the patch to dry, non-hairy skin on the upper or lower back, upper arm, or chest.
  

• Do not apply the patch to red, irritated, or wounded skin.
  

• Do not touch the sticky part of the patch with your fingers.
  

• Press down on the patch firmly for 30 seconds with the palm of your hand.
  

• Wash your hands with soap and water after applying and removing the patch.
  

• If the patch falls off, re-apply a new one immediately. Resume to apply a new patch at the same time the next day.
  

• Apply the patch at different areas. Avoid applying the patch to the exact same area of skin for at least 14 days to prevent skin irritation.
  

• Avoid prolonged exposure to external sources of heat (e.g. excessive sunlight, sauna).
  

• Do not remove the patch during bathing or swimming.
  

• Do not cut the patch.
  

• Each patch is effective for up to 24 hours.
  

• This medication needs to be taken orally or applied topically regularly for a few weeks before you feel its full benefits. Therefore, do not stop taking or applying this medication even if there are no signs of improvement at the beginning.
  

• You may check with your doctor on how long you will have to be on this medication.
  

• Do not stop taking your medication without checking with your healthcare professional.
  

What should I do if I forget to take/use this medication?

If you are taking Rivastigmine capsules and have forgotten to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose. Then take the next dose at your usual timing. Do not take two doses to make up for the missed dose.

If you are using Rivastigmine patches and have forgotten to apply the patch, apply one patch immediately. Change the patch at your usual timing the next day. Do not apply 2 patches to make up for the missed dose.

If it has been more than 3 days since you have last taken a dose or applied a patch, consult your doctor before taking or applying it again. You may need to be restarted on a lower dose.

What precautions should I take?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication

• You are taking any other medications including over-the-counter medications, supplements, traditional Chinese medicine and herbal remedies. Some of these may affect how this medication works or cause serious drug interactions.

• You have or have ever had:

  • Other drug allergies or previous skin reaction to medicinal patches/plasters

  • Medical conditions such as:

    • Heart, kidney or liver disease, slow or irregular heartbeat

    • Seizures (fits), asthma, breathing problems, stomach or intestinal ulcers, or difficulty passing urine

What are some common side-effects of this medication?

The mentioned side effects generally affect up to 10% of patients.

• Feeling tired or drowsy

  • Discuss with your doctor if you can take this medication at a different time of the day

  • Avoid driving or engaging in activities requiring concentration

• Nausea or vomiting (more common with oral capsules)

  • Take the medication with or after food

  • Take small but frequent meals and avoid fatty or spicy food

• Diarrhoea

• Drink plenty of water to replace fluid loss
  

• Light-headedness (especially during a sudden change in posture)

• Get up slowly from a sitting or lying down position to avoid falling over
  

• Skin irritation (for Rivastigmine patch)

  • Change the site of application each time, on skin that is free of wounds or rashes.

  • Avoid applying the patch to the exact same area of skin for at least 14 days.

  • If there is any sign of rash after applying the patch, speak to your doctor if the rash does not go away after 2 days.

• Difficulty sleeping (more common for patch)

  • Discuss with your doctor if you can take this medication at a different time of the day

  • Avoid daytime naps; listen to relaxing music at bedtime

  • Avoid overeating or drinking before bedtime

  • Limit caffeine intake to at least 8 hours before bedtime

• Headache

• Loss of appetite or weight loss

• Stomach discomfort

• Increased sweating

• Tremors

Most of the side effects listed here will improve with time. Speak to your doctor if they are bothersome, get worse or are affecting your daily life.

What are some rare but serious side-effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue

• Difficulty in breathing

• Itchy skin rashes over your whole body

Rarely this medication may cause:

• Seizures (fits)

• Severe stomach pain and vomiting of blood or material that looks like coffee grounds; bloody or black tarry stools (signs and symptoms of gastrointestinal bleeding)

• Fainting episodes or increased incidence of falling

• Difficulty or pain in passing urine

• Chest pain, slow or irregular heartbeat

• Seeing or hearing things that are not present (hallucinations)

• Anxiety, agitation or low mood

If you experience any of these side effects, you should stop your medication and inform your healthcare professional immediately.

Please also take note that not all possible side effects are listed above. If you have any concerns about your medication, please consult your doctor or pharmacist.

What food or medication should I avoid when I take this medication?

Avoid drinking alcohol while taking this medication as it may cause too much drowsiness.

How should I store this medication?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children.

How should I throw away this medication safely?

Pack this medication into a trash bag and seal it tightly before throwing it into the rubbish chute or bin.

For Rivastigmine patch, fold the sticky sides together, place the folded patch into the empty pouch of the new patch and discard it into a trash bag.

Disclaimers

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

Last updated on Oct 2021