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What Is Rivastigmine (Exelon)?

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/are the ingredient[s] 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

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, 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 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

Dosing information

For the oral route of rivastigmine, the recommended dosage for Alzheimer’s disease is 6 to 12 mg daily, broken up into two doses. To start the drug, initial treatment should be 1.5mg twice a day with meals (morning and evening).2 After being on this dosage for at least two weeks, if this is well tolerated, the dosage should be increased to 3mg twice a day.2 Increases to 4.5mg and 6mg twice a day should be done incrementally, with the previous dosage being well tolerated for at least two weeks prior to increasing the dose.2 The maximum dose is 6mg twice daily, for a total of 12mg daily.2

If you’re using the rivastigmine patch, treatment should start with one 4.6mg/24 hr patch on the skin once daily.3 After at least 4 weeks on this dosage, the dosage can be increased if well tolerated. If the 9.5mg/24hr patch is effective and tolerated, this dose should be maintained for as long as therapeutic benefit continues.3 If cognitive symptoms start to arise, a patch with the dosage of 13.3mg/24hr should be applied.3 At each dosage, the patch should be replaced every 24 hours.

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

Written by: Jaime Rochelle Herndon | Last reviewed: June 2019
  1. Alzheimer’s Association. Medications for Memory. 2019. https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory Accessed February 26, 2019.
  2. Exelon (oral) prescribing information. 2018. https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/exelon.pdf Accessed February 27, 2019.
  3. Exelon (patch) prescribing information. 2018. https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/exelon.pdf Accessed February 27, 2019.
  4. Alzheimer’s News Today. Exelon (Rivastigmine). 2019. https://alzheimersnewstoday.com/alzheimers-disease-treatment/approved-drugs/exelon-rivastigmine/ Accessed February 27, 2019.