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Rivastigmine (Absorbed through the skin)

Rivastigmine (riv-a-STIG-meen)

Treats dementia (memory loss and mental changes) associated with Alzheimer disease or Parkinson disease. This medicine is an acetylcholinesterase inhibitor.

Brand Name(s):

Exelon

There may be other brand names for this medicine.

When This Medicine Should Not Be Used:

Do not use this medicine if you have had an allergic reaction to rivastigmine or to similar medicines, such as neostigmine (Prostigmin®), physostigmine (Antilirium®), or pyridostigmine (Mestinon®, Regonol®).

How to Use This Medicine:

Patch

  • Your doctor will tell you how many patches to use, where to apply them, and how often to apply them. Do not use more patches or apply them more often than your doctor tells you to.Change the patch at the same time each day.
  • Wash your hands with soap and water before and after applying a patch.Do not touch your eyes after you touch the patch.
  • Do not remove the patch from the pouch until you are ready to use it. Open the pouch by carefully cutting on the dotted line with a pair of scissors. Do not cut the patch. Save the pouch, because you will need it later to dispose of the patch after use.
  • The patient instructions will show the body areas where you can wear the patch. When putting on each new patch, choose a different place within these areas. Do not put the new patch on the same place you wore the last one. Be sure to remove the old patch before applying a new one.This patch is usually applied to the upper or lower back, upper arm, or chest. Do not put a new patch in the exact same spot for at least 14 days.
  • Apply the patch to a clean, dry, and hairless skin area. Do not put cream, lotion, or powder on the skin area where the patch will be placed.Do not put the patch over burns, cuts, or irritated skin.Do not put the patch on an area where it could be rubbed off by tight clothing.
  • Do not expose the patch to direct sources of heat, such as heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds, or direct sunlight, for long periods of time.
  • Put on a new patch if the old one falls off. Do not put the old one back on, and do not use tape or a bandage to hold a patch that is loose. The patch should stay in place, even when you are showering, bathing, or swimming.
  • Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.

If a dose is missed:

  • If you forget to wear or change a patch, put one on as soon as you can. If it is almost time to put on your next patch, wait until then to apply a new patch and skip the one you missed. Do not apply extra patches to make up for a missed dose.
  • If you go 3 days in a row or longer without wearing a patch, do not apply a new one until you have talked to your doctor. You might need to go back to a lower dose.

How to Store and Dispose of This Medicine:

  • Store the patches at room temperature in a closed container, away from heat, moisture, and direct light.
  • Fold the used patch in half with the sticky sides together. Throw any used patch away so that children or pets cannot get to it. You will also need to throw away old patches after the expiration date has passed. Put the used patch in the pouch that it came in, and throw away both the pouch and the patch.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

  • Make sure your doctor knows if you are using an NSAID pain or arthritis medicine, such as aspirin, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, or Voltaren®.
  • Make sure your doctor knows if you also use another acetylcholinesterase inhibitor such as neostigmine (Prostigmin®), physostigmine (Antilirium®), or pyridostigmine (Mestinon®, Regonol®). Tell your doctor if you also use an anticholinergic medicine, such as allergy or cold medicine (diphenhydramine, Benadryl®), medicine to treat bladder or bowel problems (such as dicyclomine, oxybutynin, tolterodine, trospium, Bentyl®, Detrol®, Ditropan®, Sanctura®), asthma medicine (such as ipratropium, Atrovent®), or medicine for motion or travel sickness (such as scopolamine, Transderm-Scop®).

Warnings While Using This Medicine:

  • Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, heart disease, or trouble urinating. Tell your doctor if you have a history of stomach ulcers, seizures, or asthma or other breathing problems.
  • Always remove the used patch before you put on a new one, or you could have serious side effects. If you wear more than 1 patch on your body at the same time, you will get too much medicine. If you accidentally use more than 1 patch at a time, call your doctor right away.
  • This medicine might cause nausea, vomiting, diarrhea, loss of appetite, and weight loss. Tell the doctor if any of these problems are severe, because they could cause other health problems such as dehydration.
  • This medicine may cause changes in your heartbeat. This is more likely if you already have a heart rhythm problem, such as sick sinus syndrome.
  • Do not apply a new patch if you have not worn one for 3 days in a row or longer. Ask your doctor how to start treatment again, because you may need to go back to a lower dose.
  • This medicine may cause serious skin reactions such as blistering, burning, crusting, dryness, flaking, itching, scaling, severe redness, soreness, or swelling of the skin. Call you doctor right away if these skin reactions spread beyond the patch size, if they get worse, or if symptoms do not improve within 48 hours after you remove the patch.
  • This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous until you know how this medicine affects you.
  • Tell any doctor or dentist who treats you that you are using this medicine. You may need to stop using this medicine several days before you have surgery or medical tests.
  • Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
  • Bloody or black, tarry stools
  • Decrease in how much or how often you urinate
  • Seizures, tremors, twitching or muscle movements you cannot control, problems with balance or walking
  • Severe appetite loss or weight loss
  • Severe lightheadedness or fainting
  • Severe nausea, vomiting, diarrhea, stomach pain
  • Slow or uneven heartbeat

If you notice these less serious side effects, talk with your doctor:

  • Dizziness, headache
  • Loss of appetite, weight loss
  • Mild nausea, vomiting, diarrhea
  • Mild redness or itching where the patch is applied
  • Trouble sleeping

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088


Last Updated: 4/4/2014

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