rivastigmine

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

Feb 16, 2017 | Posted by in PHARMACY | Comments Off on rivastigmine

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