Class
- Cholinesterase inhibitor
Rivastigmine
Commonly Prescribed for
(FDA approved in bold)
- Alzheimer dementia (AD) (mild or moderate)
- Dementia associated with Parkinson’s Disease (PD)
- Dementia with Lewy Bodies (DLB)
- Vascular dementia
Rivastigmine
How the Drug Works
- Increases the concentration of acetylcholine through reversible inhibition of acetylcholinesterase, which increases availability of acetylcholine. Also inhibits butyrylcholinesterase. A deficiency of cholinergic function is felt to be important in producing the signs and symptoms of AD. May interfere with amyloid deposition
- Although symptoms of AD can improve, rivastigmine does not prevent disease progression
Rivastigmine
How Long Until It Works
- Typically 2–6 weeks at a given dose, but effect is best observed over a period of months
Rivastigmine
If It Works
- Continue to use but symptoms of dementia usually continue to worsen
Rivastigmine
If It Doesn’t Work
- Non-pharmacologic measures are the basis of dementia treatment. Maintain regular schedules and routines. Avoid prolonged travel, unnecessary medical procedures or emergency room visits, crowds, and large social gatherings
- Limit drugs with sedative properties such as opioids, hypnotics, antiepileptic drugs and tricyclic antidepressants
- Treat other disorders which can worsen symptoms such as hyperglycemia or urinary difficulties
Rivastigmine
Best Augmenting Combos for Partial Response or Treatment-Resistance
- Addition of the NMDA receptor antagonist memantine may be beneficial
- Treat depression or apathy, if present, with SSRIs. Avoid tricyclic antidepressants in demented patients due to risk of confusion
- For significant confusion and agitation avoid typical neuroleptics (especially in DLB) because of the risk of neuroleptic malignant syndrome. Atypical antipsychotics (risperidone, quetiapine, olanzapine, clozapine) can be used instead
Rivastigmine
Tests
- None required
Adverse Effects (AEs)
Rivastigmine
How Drug Causes AEs
- Acetylcholinesterase and butyrylcholinesterase inhibition in the CNS and PNS
Rivastigmine
Notable AEs
- GI AEs (nausea/vomiting, diarrhea, anorexia, increased gastric acid secretion and weight loss) are most common
- Fatigue, depression, dizziness, increased sweating and headache
Rivastigmine
Life-Threatening or Dangerous AEs
- Rarely bradycardia or heart block causing syncope. Generalized convulsions. Increases gastric acid secretions which can predispose to GI bleeding
Rivastigmine
Weight Gain
- Unusual
- Weight loss is more common
Rivastigmine
Sedation
- Unusual