III. Mechanism

  1. See Acetylcholinesterase Inhibitor
  2. Carbamate-based noncompetitive Cholinesterase Inhibitor
  3. Inhibits butyrylcholinesterase and acetylcholinesterase
  4. Increases Cholinergic transmission

IV. Pharmacokinetics: Oral Route

  1. Peak: 1 hour
  2. Duration: 10 hours

V. Drug Interactions

  1. No significant Drug Interactions

VI. Efficacy

  1. Modestly improves scores on neuropsychological tests
  2. Benefits decrease after 40 weeks of treatment

VII. Adverse Effects

  1. See Acetylcholinesterase Inhibitor
  2. Specific adverse effects reported for Rivastigmine, not seen with other Acetylcholinesterase Inhibitors
    1. Abdominal Pain
    2. Atrial Fibrillation
    3. Myocardial Infarction

VIII. Dosing

  1. Oral Route
    1. Initial: 1.5 mg orally twice daily with food for at least 2 weeks (4 weeks for Lewy Body Dementia)
    2. Next: 3 mg orally twice daily with food for at least 2 weeks (4 weeks for Lewy Body Dementia)
    3. Next: 4.5 mg orally twice daily with food for at least 2 weeks (4 weeks for Lewy Body Dementia)
    4. Next: 6 mg orally twice daily with food
  2. Transdermal Patch
    1. Initial: 4.6 mg patch every 24 hours for at least 4 weeks
    2. Next: 9.5 mg patch every 24 hours for at least 4 weeks
    3. Next: 13.3 mg patch every 24 hours

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Cost: Medications

rivastigmine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
RIVASTIGMINE 1.5 MG CAPSULE Generic $0.99 each
RIVASTIGMINE 13.3 MG/24HR PTCH Generic $7.45 each
RIVASTIGMINE 3 MG CAPSULE Generic $1.00 each
RIVASTIGMINE 4.5 MG CAPSULE Generic $0.93 each
RIVASTIGMINE 4.6 MG/24HR PATCH Generic $7.53 each
RIVASTIGMINE 6 MG CAPSULE Generic $0.88 each
RIVASTIGMINE 9.5 MG/24HR PATCH Generic $7.35 each
exelon (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
EXELON 13.3 MG/24HR PATCH Generic $7.45 each
EXELON 4.6 MG/24HR PATCH Generic $7.53 each
EXELON 9.5 MG/24HR PATCH Generic $7.35 each

Ontology: rivastigmine (C0649350)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C072506
SnomedCT 323368009, 395868008
English (S)-N-ethyl-3-((1-dimethyl-amino)ethyl)-N-methylphenylcarbamate, Carbamic acid, ethylmethyl-, 3-(1-(dimethylamino)ethyl)phenyl ester, (S)-, (R-(R*,R*))-2,3-dihydroxybutanedioate (1:1), rivastigmine, rivastigmine (medication), RIVASTIGMINE, rivastigmine [Chemical/Ingredient], Rivastigmine, Rivastigmine (product), Rivastigmine (substance)
Spanish rivastigmina (producto), rivastigmina (sustancia), rivastigmina

Ontology: Exelon (C0730987)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C072506
English Exelon, rivastigmine (Exelon), exelon