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Indications & Uses
Rivastigmine Tartrate is used for the symptomatic treatment of mild to moderately severe Alzheimer's dementia. It is also used for the symptomatic treatment of mild to moderately severe dementia in patients with Idiopathic Parkinson's disease.
Pharmacology
Rivastigmine is a carbamate derivative. Its structure is related to physostigmine, but not to donepezil or tacrine. Exactly how rivastigmine works hasn't been fully worked out. It is thought to bind reversibly to cholinesterase enzymes (for example acetylcholinesterase and butyrylcholinesterase) and inactivate them. This stops acetylcholine from being broken down by hydrolysis, so the concentration of acetylcholine rises at cholinergic synapses. The anticholinesterase activity of rivastigmine is relatively specific for acetylcholinesterase and butyrylcholinesterase in the brain, compared with the same enzymes in peripheral tissues.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Rivastigmine capsules are taken twice a day, with the morning and evening meals.
Initial dose: Rivastigmine 1.5 mg twice a day.
Dose titration: The starting dose is 1.5 mg twice a day. If the patient tolerates this well after at least two weeks of treatment, the dose may go up to 3 mg twice a day. The next increases, to 4.5 mg and then 6 mg twice a day, also depend on good tolerability of the current dose. Each one may be considered after at least two weeks at that dose level.
Maintenance dose: The effective dose is 3 mg to 6 mg twice a day. To get the greatest benefit, patients should stay on the highest dose they tolerate well. The recommended maximum daily dose is 6 mg twice a day. Maintenance treatment can continue for as long as the patient is getting a therapeutic benefit.
Re-initiation of therapy: If treatment is interrupted for more than several days, restart at 1.5 mg twice daily. Then carry out the dose titration as described above.
Rivastigmine transdermal patch: Apply the patch on intact skin for a 24-hour period, and replace it with a new patch every 24 hours.
Initial dose: Start with the 4.6 mg/24 hours Rivastigmine transdermal patch.
Dose titration: After at least 4 weeks, if the patient tolerates it, increase the dose to 9.5 mg/24 hours, which is the minimum effective dose. After at least another 4 weeks, the dose may be increased to the maximum of 13.3 mg/24 hours.
Mild to moderate Alzheimer's disease and Parkinson's disease dementia: Rivastigmine transdermal patch 9.5 mg/24 hours or 13.3 mg/24 hours once daily.
Severe Alzheimer's disease: Rivastigmine transdermal patch 13.3 mg/24 hours once daily.
If treatment is interrupted for longer than 3 days, start the titration again from 4.6 mg per 24 hours.
Side Effects
Most of the side effects people report with Rivastigmine Tartrate affect the stomach and gut. Nausea is the commonest (38%), followed by vomiting (23%), and both tend to show up mainly while the dose is being titrated. In clinical studies, women were more susceptible than men to these gut-related reactions and to weight loss.
Cautions & Contraindications
Warnings & Precautions
Take care with Rivastigmine Tartrate in people who have sick sinus syndrome or conduction defects, and in those with respiratory diseases, including asthma or obstructive pulmonary disease. Cholinergic stimulation may increase gastric acid secretion. The medicine may also make urinary obstruction and seizures worse, and it may worsen extrapyramidal symptoms. Use caution in pregnancy and in lactation. Caution is also needed in renal impairment and in mild to moderate hepatic impairment. Monitor body weight during treatment with Rivastigmine Tartrate.
Contraindications
Rivastigmine Tartrate must not be given to patients who are hypersensitive to the active substance or to other carbamate derivatives.
Pregnancy & Breastfeeding
There are no clinical data on rivastigmine in pregnancy, so it should not be used during pregnancy unless it is clearly necessary. In animals, rivastigmine passes into the milk. Nobody knows whether it passes into human breast milk, so women taking rivastigmine should not breast-feed.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Use in Special Populations
Renal and hepatic impairment: Exposure to Rivastigmine Tartrate goes up in people with moderate renal impairment and in those with mild to moderate hepatic impairment. For this reason, the dosing recommendations should be followed closely, and the dose should be titrated according to how well the individual tolerates it.
Use in children: Rivastigmine Tartrate is not recommended for use in children.
Overdose
Most accidental overdoses of rivastigmine haven't caused any signs or symptoms, and almost all of the patients carried on with their rivastigmine treatment. When symptoms did appear, they included nausea, vomiting and diarrhoea, hypertension or hallucinations. Cholinesterase inhibitors are known to have a vagotonic effect on heart rate, so bradycardia and/or syncope may also occur. In one case a patient took 46 mg. After conservative management, that patient recovered fully within 24 hours.
Rivastigmine has a plasma half-life of about 1 hour, and its inhibition of acetylcholinesterase lasts about 9 hours. For this reason, if an overdose causes no symptoms, no further dose of rivastigmine should be given for the next 24 hours. If the overdose comes with severe nausea and vomiting, antiemetics should be considered. Other adverse reactions should be treated symptomatically as needed. In a massive overdose, atropine can be used. The recommended starting dose is 0.03 mg/kg of intravenous atropine sulphate, and later doses depend on how the patient responds. Scopolamine is not recommended as an antidote.
⚠️ In an emergency call 999 or go to the nearest hospital emergency department.
Storage
Keep Rivastigmine Tartrate in a cool, dry place and away from light.
Drug Interactions
Common questions about RivaCap 3 mg
What is RivaCap 3 mg Capsule?
RivaCap 3 mg Capsule is a medicine that contains Rivastigmine Tartrate. It is made by Ibn Sina Pharmaceutical Ind. Ltd. It belongs to the Drugs for Dementia group of medicines.
What is RivaCap used for?
Rivastigmine Tartrate is used for the symptomatic treatment of mild to moderately severe Alzheimer's dementia. It is also used for the symptomatic treatment of mild to moderately severe dementia in patients with Idiopathic Parkinson's disease.
What are the side effects of RivaCap?
Most of the side effects people report with Rivastigmine Tartrate affect the stomach and gut. Nausea is the commonest (38%), followed by vomiting (23%), and both tend to show up mainly while the dose is being titrated.
Can I take RivaCap during pregnancy or while breastfeeding?
There are no clinical data on rivastigmine in pregnancy, so it should not be used during pregnancy unless it is clearly necessary. In animals, rivastigmine passes into the milk. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
What happens if I take too much RivaCap?
Most accidental overdoses of rivastigmine haven't caused any signs or symptoms, and almost all of the patients carried on with their rivastigmine treatment. When symptoms did appear, they included nausea, vomiting and diarrhoea, hypertension or hallucinations. In an emergency call 999 or go to the nearest hospital emergency department.
How should I store RivaCap?
Keep Rivastigmine Tartrate in a cool, dry place and away from light.
Can I take other medicines with RivaCap?
Some medicines can interact with Rivastigmine Tartrate, for example: Digoxin, Fluoxetine, Diazepam, Warfarin Sodium. Tell your doctor or pharmacist about every medicine you take.
Is there a cheaper medicine with the same ingredient?
RivaCap is already among the lowest-priced brands of Rivastigmine Tartrate at this strength.
Do I need a prescription for RivaCap?
RivaCap is a prescription (Rx) medicine. Take it as your doctor advises.