Rivastigmine side effects Exelon medication dosage

Rivastigmine (sold under the trade name Exelon) is a cholinesterase inhibitor drug for the treatment of mild to moderate dementia of the Alzheimer’s type and dementia due to Parkinson's disease. Additional medications used for Alzheimer's disease include donepezil, rivastigmine, and galantamine.

Rivastigmine side effects
Side effects include nausea and vomiting. Administration with a rivastigmine transdermal patch has fewer side effects compared to oral. A transdermal patch of rivastigmine is available that allows to obtain a lower peak of concentration, less gastro-intestinal side effects, and an efficacy similar to the oral capsules of rivastigmine.

Rivastigmine side effects may include heart block
Complete atrioventricular block associated with rivastigmine therapy.
Am J Health Syst Pharm. 2008; Department of Cardiology, Selcuk University Medical Faculty, Konya, Turkey.
A case of complete atrioventricular block associated with rivastigmine use is presented. A 67-year-old Turkish woman with Alzheimer's disease was admitted to the hospital because of dizziness and syncope. Her medical history included diagnoses of hypertension (treated with amlodipine 5 mg daily) and diabetes mellitus (treated with nateglinide 120 mg daily). She had been taking both drugs for over five years. She had also been taking rivastigmine 6 mg p.o. daily for five months for the treatment of Alzheimer's disease. She had experienced dizziness since the onset of rivastigmine therapy but had not reported it to any health care provider. On admission, she had a blood pressure measurement of 90/60 mm Hg and a pulse rate of 34 beats/min. A 12-lead electrocardiogram revealed complete atrioventricular block. Echocardiography results, blood electrolyte levels, and cardiac biochemical markers were normal. After initial evaluation, a temporary transvenous pacemaker was implanted via the right femoral vein. Amlodipine and rivastigmine were discontinued. On the first day of hospitalization, a coronary angiogram revealed normal coronary anatomy. Two days later, the complete atrioventricular block resolved spontaneously to sinus rhythm. Rivastigmine 6 mg p.o. daily was reinitiated, and complete atrioventricular block recurred on the fourth day of therapy. A VVI permanent pacemaker was implanted on the fifth day of hospitalization. Amlodipine and rivastigmine were reinitiated. The patient continued rivastigmine 6 mg p.o. daily after permanent pacemaker implantation. A three-month follow-up appointment revealed that no further syncope episodes or dizziness had occurred. A 67-year-old woman developed complete rivastigmine side effect of atrioventricular block after receiving this medication for the treatment of Alzheimer's disease.

Switching from Donepezil Tablets to Rivastigmine Transdermal Patch in Alzheimer's Disease; 
American Journal of Alzheimer's Disease and Other Dementias 2009. Sadowsky CH, Dengiz A, Olin JT, Brannan S;
Evaluate safety and tolerability of switching from donepezil to rivastigmine transdermal patch in patients with mild to moderate Alzheimer's disease. Prospective, parallel-group, open-label study to evaluate immediate or delayed switch from 5-10 mg/day donepezil to 4.6 mg/24 h rivastigmine following a 4-week treatment period. Rates of discontinuation due to any reason or adverse events were similar between groups. Incidences of gastrointestinal adverse events were 3.8% in the immediate and 0.8% in the delayed switch group. No patients discontinued secondary to nausea and vomiting. Discontinuations due to application site reactions were low (2.3%). Asymptomatic bradycardia was more common following the immediate switch; however, these patients had coexisting cardiac comorbidities. Both switch strategies were safe and well tolerated. The majority of patients may be able to switch directly to rivastigmine patches without a withdrawal period. Appropriate clinical judgment should be used for patients with existing bradycardia or receiving beta blockers.