What Is Rivastigmine (Exelon)?

Reviewed by: HU Medical Review Board | Last reviewed: June 2022 | Last updated: July 2022

Several kinds of drugs are approved to treat the cognitive symptoms of Alzheimer’s disease, including certain drugs known as cholinesterase inhibitors. Cholinesterase inhibitors help to prevent the breakdown of acetylcholine, which is a neurotransmitter involved in learning and memory.1 By preventing the breakdown of the chemical, communication between nerve cells in the brain may be improved. This can lead to a slowing down of symptoms or a delay in exhibiting symptoms.

One of these inhibitors is rivastigmine, also known as the brand name drug Exelon. It is approved to treat mild to moderate Alzheimer’s disease, and comes in two forms: oral and transdermal (a patch for the skin). Talk to your doctor about the risks and benefits of each form and which one is best for you.

What is the ingredient in rivastigmine?

The rivastigmine capsules contain the active ingredient rivastigmine tartrate, and the patch has the active ingredient rivastigmine.2,3 The patch also has a backing layer, adhesive matrix and an overlapping release liner, which is removed before use.3 There is also an oral solution available as well.

How does rivastigmine work?

Neurotransmitters are chemicals in the brain that help transmit communication between cells and can help with cognition, mood, and memory, among other things. Enzymes can trigger chemical reactions with neurotransmitters, and rivastigmine works on one of these enzymes called acetylcholinesterase. Acetylcholinesterase breaks down the neurotransmitter acetylcholine. Rivastigmine helps to block or inhibit acetylcholinesterase to keep it from breaking down acetylcholine, thereby increasing acetylcholine levels in the brain, encouraging more communication between nerve cells and potentially improving memory and cognition.4 It is hypothesized that some Alzheimer’s symptoms results from reduced levels of acetylcholine, as well as the lack of cells that receive the neurotransmitter, due to cell death.4

What are the possible side effects of rivastigmine?

Common side effects of rivastigmine include gastrointestinal disturbance, decreased appetite or lack of appetite, weight loss, significant nausea, vomiting, dizziness/drowsiness, and diarrhea.2 Patients who have vomiting or diarrhea also run the risk of dehydration.

Other possible side effects can include fatigue, hypertension, abdominal pain, and insomnia.2 For the Exelon patch, in addition to the side effects listed above, skin reactions like itching and redness at the application site were also seen, although some individuals taking oral Exelon also reported allergic dermatitis.2,3

These are not all the possible side effects of rivastigmine. Patients should talk to their doctor about what to expect with treatment with rivastigmine.

If you start taking rivastigmine either orally or transdermally (from the patch), tell your doctor about any side effects that you might notice, or any abnormal symptoms you might experience.

Things to know about rivastigmine

If you have a history of kidney or liver issues, tell your doctor, as rivastigmine might need to be given at lower levels.2 This drug can also be affected by low body weights or high body weights, so this needs to be taken into consideration as well. If you’re using the patch and miss 3 consecutive days, tell your doctor, as you might have to restart the dosing schedule.3

For more information, read the full prescribing information of rivastigmine (oral route) and rivastigmine (transdermal).

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