Exelon (rivastigmine) is a prescription medication specifically formulated for the treatment of mild to moderate dementia associated with Alzheimer’s disease and Parkinson’s disease. As a cholinesterase inhibitor, it works by increasing the levels of certain chemicals in the brain involved in memory, thinking, and reasoning. This medication is available in multiple formulations, including capsules and transdermal patches, to accommodate individual patient needs and preferences, offering a tailored approach to cognitive symptom management under strict medical supervision.

Features

• Active pharmaceutical ingredient: Rivastigmine
• Available formulations: Oral capsules (1.5 mg, 3 mg, 4.5 mg, 6 mg) and transdermal patches (4.6 mg/24 h, 9.5 mg/24 h)
• Pharmacological class: Reversible cholinesterase inhibitor
• Administration: Once or twice daily oral dosing, or once-daily transdermal application
• Prescription status: Schedule 4 controlled substance (varies by jurisdiction)

Benefits

• Enhances cognitive function including memory, attention, and reasoning abilities
• May help slow the progression of dementia symptoms in Alzheimer’s and Parkinson’s patients
• Improves overall functional capacity and activities of daily living
• Transdermal patch formulation reduces gastrointestinal side effects
• Provides flexible dosing options for personalized treatment regimens
• Supported by extensive clinical research and long-term safety data

Common use

Exelon is primarily indicated for the treatment of mild to moderate dementia associated with Alzheimer’s disease. It is also approved for the treatment of mild to moderate dementia in patients with Parkinson’s disease. The medication is used as part of a comprehensive treatment approach that includes non-pharmacological interventions and caregiver support. Treatment is typically initiated when symptoms begin to interfere with daily functioning and is continued based on therapeutic response and tolerability.

Dosage and direction

Initial dosing: For oral capsules, begin with 1.5 mg twice daily with food. For transdermal patches, start with 4.6 mg/24 h applied once daily to clean, dry, intact skin on the upper or lower back, upper arm, or chest. Avoid areas with irritation, redness, or cuts.

Titration: Increase dose by 1.5 mg twice daily at minimum 2-week intervals based on tolerability, to a maximum of 6 mg twice daily for oral formulation. For transdermal patches, may increase to 9.5 mg/24 h after minimum 4 weeks if well tolerated.

Administration: Take oral capsules with food to reduce nausea. Apply patches to different skin sites daily, avoiding reapplication to the same site within 14 days. Remove previous patch before applying new one.

Special populations: Renal or hepatic impairment may require dosage adjustment. Not recommended for severe impairment.

Precautions

Monitor for gastrointestinal effects including nausea, vomiting, and weight loss. Assess cognitive and functional status regularly. Use caution in patients with history of peptic ulcer disease or gastrointestinal bleeding. Monitor for urinary obstruction and seizures. Patients with cardiac conduction abnormalities or history of syncope require close monitoring. Transdermal patches may cause skin reactions; rotate application sites and monitor for dermatitis. Avoid abrupt discontinuation. Notify healthcare provider of any surgical procedures, as anesthesia interactions are possible.

Contraindications

Hypersensitivity to rivastigmine or any components of the formulation. History of severe cutaneous reactions to transdermal patches. Concurrent use with other cholinesterase inhibitors. Patients with severe liver impairment. History of drug-induced extrapyramidal symptoms. Untreated urinary tract obstruction or gastrointestinal obstruction.

Possible side effects

Very common (>10%): Nausea, vomiting, diarrhea, dizziness, headache, abdominal pain, decreased appetite

Common (1-10%): Weight loss, dyspepsia, fatigue, insomnia, tremor, sweating, agitation, anxiety, syncope, bradycardia, hypertension

Uncommon (0.1-1%): Peptic ulcer, gastrointestinal bleeding, urinary tract infection, depression, hallucinations, extrapyramidal symptoms, skin reactions (with patch)

Rare (<0.1%): Seizures, pancreatitis, hepatic enzyme elevations, severe vomiting with esophageal rupture

Drug interaction

Anticholinergic agents: Reduced efficacy of both medications Cholinergic agents: Additive effects, increased side effects Beta-blockers: Enhanced bradycardic effect Neuromuscular blocking agents: Prolonged neuromuscular blockade NSAIDs: Increased risk of gastrointestinal bleeding Metoclopramide: May exacerbate extrapyramidal symptoms Paroxetine: Increased rivastigmine concentrations

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed one. For transdermal patches, apply a new patch as soon as remembered and continue with regular schedule. If a patch falls off, apply a new patch to a different site and continue with original change schedule.

Overdose

Symptoms: Severe nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, seizures, muscle weakness

Management: Discontinue medication immediately. Provide supportive care including intravenous fluids. Atropine may be used as an antidote, with initial dose of 0.03 mg/kg IV, titrated to effect. Monitor cardiac function continuously. Symptomatic treatment for gastrointestinal effects. Dialysis not effective due to high protein binding.

Storage

Store at room temperature (15-30°C). Keep in original container, tightly closed. Protect from moisture. Do not freeze. Keep transdermal patches in sealed pouch until use. Keep out of reach of children and pets. Do not use beyond expiration date. Dispose of used patches by folding adhesive sides together and discarding in household trash.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Exelon is a prescription medication that must be used under the supervision of a qualified healthcare professional. Individual results may vary. Always follow your healthcare provider’s instructions regarding dosage and administration. Report any adverse effects to your physician immediately. Not all possible interactions or side effects are listed here.

Reviews

Clinical studies demonstrate that Exelon provides statistically significant improvements in cognitive function, activities of daily living, and global functioning compared to placebo. Many patients and caregivers report improved quality of life and slower symptom progression. The transdermal formulation is particularly noted for improved gastrointestinal tolerability. However, individual responses vary, and some patients may not experience significant benefits or may discontinue due to side effects. Long-term studies show maintained efficacy with appropriate dose titration and management.