Rivastigmine is a reversible, non-competitive, brain-selective, dual inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), used for the symptomatic treatment of mild to moderate dementia of the Alzheimer's type and dementia associated with Parkinson's disease. The 1.5mg strength is typically the initial dose for titration.
Adult: Initial dose: 1.5 mg twice daily. Titration: Increase by 1.5 mg twice daily increments at minimum intervals of 2 weeks, based on tolerability. Effective dose range: 3 mg to 6 mg twice daily (6-12 mg/day). Maximum recommended oral dose: 6 mg twice daily (12 mg/day).
Note: Administer twice daily, in the morning and evening, with food to improve tolerability and increase bioavailability. Capsules should be swallowed whole with a glass of water. Do not crush or chew.
Rivastigmine exerts its therapeutic effect by enhancing cholinergic function in the cerebral cortex and hippocampus, brain regions critically involved in memory, attention, and learning, which are deficient in Alzheimer's and Parkinson's disease dementia. It does this by inhibiting the enzymes that break down acetylcholine.
Pregnancy: Category B (Animal studies show no risk, but no adequate human studies). Use only if potential benefit justifies potential risk to the fetus. Not indicated for women of childbearing potential.
Driving: May cause dizziness, somnolence, and blurred vision. Patients should be cautioned about operating machinery or driving until they know how the drug affects them.
| Metoclopramide | Additive extrapyramidal effects; increased risk of parkinsonian symptoms. | Major |
| Beta-blockers (e.g., Propranolol, Atenolol) | Additive bradycardic effect; risk of syncope, heart block. | Major |
| Other Cholinesterase Inhibitors (Donepezil, Galantamine) | Additive cholinergic effects and toxicity; contraindicated. | Major |
| Anticholinergic drugs (e.g., Atropine, Oxybutynin, Tricyclic Antidepressants) | Pharmacological antagonism; may reduce rivastigmine efficacy. | Moderate |
| Cholinergic agonists (e.g., Bethanechol) | Additive cholinergic effects; risk of toxicity. | Moderate |
| Succinylcholine-type muscle relaxants | Prolonged neuromuscular blockade during anesthesia. | Moderate |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | Increased risk of gastrointestinal bleeding. | Moderate |
Same composition (Rivastigmine (1.5mg)), different brands: