rivastigmine tartrate


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Related to rivastigmine tartrate: Fenofibrate, Exelon

rivastigmine tartrate

Pharmacologic class: Cholinesterase inhibitor

Therapeutic class: Anti-Alzheimer's drug

Pregnancy risk category B

Action

Unknown. Thought to enhance cholinergic function by elevating acetylcholine levels in brain through reversible inhibition of its hydrolysis by cholinesterase.

Availability

Capsules: 1.5 mg, 3 mg, 4.5 mg, 6 mg

Oral solution: 2 mg/ml

Transdermal patch: 4.6 mg/24 hours, 9.5 mg/24 hours

Indications and dosages

Mild to moderate dementia of Alzheimer's disease

Adults: Initially, 1.5 mg P.O. b.i.d. May increase to 3 mg b.i.d. after 2 weeks; may increase further to 4.5 mg b.i.d. and 6 mg b.i.d., if tolerated, after 2 weeks at previous dosage. Typical effective range is 6 to 12 mg/day, up to a maximum of 12 mg/day. Or initially, apply one 4.6-mg patch to the skin q 24 hours. After minimum of 4 weeks, may increase to maintenance dose of one 9.5-mg patch applied to the skin q 24 hours.

Mild to moderate dementia of Parkinson's disease

Adults: Initially, 1.5 mg P.O. b.i.d. May increase to 3 mg b.i.d. after 2 weeks; may increase further to 4.5 mg b.i.d. and 6 mg b.i.d. if tolerated, after 4 weeks at previous dosage. Typical effective range is 3 to 12 mg/day, up to a maximum of 12 mg/day. Or initially, apply one 4.6-mg patch to the skin q 24 hours. After minimum of 4 weeks, may increase to maintenance dose of one 9.5-mg patch applied to the skin q 24 hours.

Off-label uses

• Huntington's disease

Contraindications

• Hypersensitivity to drug, its components, or carbamate derivatives

Precautions

Use cautiously in:
• renal or hepatic impairment, diabetes mellitus, obstructive pulmonary disease, neurologic conditions that can cause seizures, peptic ulcers, GI bleeding, supraventricular conduction disorders
• patients older than age 85
• pregnant patients.

Administration

• Give with food in morning and evening.

Adverse reactions

CNS: depression, dizziness, headache, confusion, insomnia, psychosis, hallucinations, anxiety, tremor, drowsiness, fatigue, syncope, asthenia

CV: chest pain, hypertension, peripheral edema

EENT: rhinitis, pharyngitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, eructation, dyspepsia, anorexia

GU: urinary tract infection, urinary incontinence

Musculoskeletal: back pain, joint pain, bone fractures

Respiratory: upper respiratory infection, cough, bronchitis

Skin: rash, diaphoresis

Other: weight loss, pain, flulike symptoms

Interactions

Drug-drug.Anticholinergics: interference with anticholinergic effects

Cholinergic agonists (such as bethanechol), succinylcholine and similar neuromuscular blockers: synergistic effects

Drug-herbs.S-adenosylmethionine (SAM-e), St. John's wort: increased risk of serotonin syndrome

Drug-behaviors.Nicotine use: increased drug clearance

Patient monitoring

• Monitor patient's nutritional and hydration status, especially at start of therapy.
• Assess vital signs and cardiovascular status. Stay alert for chest pain and peripheral edema.
• Closely monitor cognitive status, particularly memory. Report significant decline or improvement.
• Assess temperature. Watch for fever and other signs and symptoms ofinfection.

Patient teaching

• Instruct caregiver to give with food in morning and evening.
• Instruct caregiver to use dosing syringe provided with oral solution to withdraw prescribed amount of solution from container; patient may swallow directly from syringe. Or, drug may be mixed with a small glass of water, cold fruit juice, or soda; stir mixture and have patient drink entire amount.
• Instruct caregiver how to apply transdermal patch.
• Inform caregiver that drug initially may worsen CNS impairment. Recommend appropriate safety measures.
• Tell caregiver that memory improvement generally is subtle and that drug works by preventing further memory loss.
• Inform caregiver that drug commonly causes nausea, vomiting, decreased appetite, and weight loss, especially at start of therapy.
• Advise caregiver to watch for and report weight loss, dehydration, and signs and symptoms of GI bleeding.
• Tell caregiver that drug interacts with many over-the-counter products and nicotine. Advise him to discuss these products with prescriber before giving to patient.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.

References in periodicals archive ?
The EXELON([R])* brand and generic Rivastigmine tartrate had U.
Rivastigmine tartrate is indicated for the treatment of mild to moderate dementia of the Alzheimer's type and for the treatment of mild to moderate dementia associated with Parkinson's disease.
Reddy's will not launch its generic Rivastigmine Tartrate capsules until sometime before the expiry of the Orange Book patents claiming Rivastigmine.
announced today that Breckenridge and Alembic Pharmaceuticals Limited have settled their Paragraph IV patent litigation with Novartis concerning Rivastigmine Tartrate Capsules, a generic version of Exelon by Novartis, and that the U.