Drug Name

Exelon (Rivastigmine)

Drug Uses

This medicine is a cholinesterase inhibitor used to treat loss of memory and thinking problems due to Alzheimer or Parkinson disease. It may also be used to treat other conditions as determined by your doctor.

How Taken

Exelon usually is taken twice daily with meals. Due to gastrointestinal side effects that can be seen early in therapy, exelon therapy is generally started at a low dose, often 1.5 mg twice daily, and gradually increased not more than once every 2 weeks. The goal usually is 6 mg twice daily. If a patient develops severe gastrointestinal side effects such as upset stomach and vomiting, he or she may need to stop taking exelon for a few doses and then start taking it again at the same dose or a lower dose. Drugs with anticholinergic effects and which cross into the brain, such as atropine, benztropine (Cogentin), and trihexyphenidyl (Artane) oppose the effects of exelon and should be avoided during therapy with exelon. Unlike donepezil (Aricept), exelon does not cause the blood levels of other medications to rise and increase their risk for side effects.

Drug Class and Mechanism

Exelon is an oral medication used to treat patients with Alzheimer's disease. Exelon is in a class of drugs called cholinesterase inhibitors that also includes tacrine (Cognex), donezepil (Aricept), and galantamine (Reminyl). Cholinesterase inhibitors inhibit (block) the action of acetylcholinesterase, the enzyme responsible for the destruction of acetylcholine. Acetylcholine is one of several neurotransmitters in the brain, chemicals that nerve cells use to communicate with one another. Reduced levels of acetylcholine in the brain are believed to be responsible for some of the symptoms of Alzheimer's disease. By blocking the enzyme that destroys acetylcholine, exelon increases the concentration of acetylcholine in the brain, and this increase is believed to be responsible for the improvement in thinking seen with exelon.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Storage

Store this medicine at room temperature below 77 degrees F (25 degrees C) in a tightly-closed container, away from heat and light.

Warnings/Precautions

Do not stop using this medicine without first checking with your doctor. Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using this medicine. This medicine may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to this medicine. Using this medicine alone, with other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Before you begin taking any new medicine, either prescription or over-the-counter, check with your doctor or pharmacist. For women: it is unknown if this medicine is excreted in breast milk. Do not breast-feed while taking this medicine.

Possible Side Effects

Side effects, that may go away during treatment, include nausea, vomiting, loss of appetite, dizziness, drowsiness, increased sweating, tremor, weakness, unusual fatigue, weight loss, stomach pain, indigestion, or gas. If they continue or are bothersome, check with your doctor. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist.

More Information

Inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking. Additional monitoring of your dose or condition may be needed if you are also taking bethanechol. Inform your doctor of any other medical conditions, allergies, pregnancy, or breast-feeding. Additional monitoring of your dose or condition may be needed if you have history of asthma, other breathing disorders (e.g., obstructive pulmonary disease), certain heart conditions (e.g., sick sinus syndrome), eating disorders, or seizures. Contact your doctor or pharmacist if you have any questions or concerns about taking this medicine.