Exelon side effects — what to expect and how to manage them

Starting Exelon (rivastigmine) can help with memory and thinking in dementia, but it often brings side effects too. Knowing the usual problems, how the patch differs from pills, and simple fixes makes the treatment easier for both patients and caregivers.

Common side effects and what they feel like

The most frequent reactions are stomach-related: nausea, vomiting, diarrhea, and loss of appetite. Those can cause weight loss if they last. You may also see dizziness, headache, tremor, and tiredness. With the oral form, digestive symptoms tend to be stronger at first. The patch often causes less nausea but can irritate the skin where it’s applied.

Less common but serious signs include a slow heart rate (bradycardia), fainting, severe muscle weakness, seizure, or signs of gastrointestinal bleeding (black or tarry stools). If any of those occur, get medical help right away.

Practical tips to reduce side effects

Start low and go slow. Doctors usually begin at a low dose and raise it slowly to cut down on nausea and dizziness. If pills upset the stomach, try taking them with food — that helps. If nausea or diarrhea continues, ask the prescriber about switching to the patch; many people tolerate the patch better.

For skin irritation from the patch, rotate application sites and make sure the skin is clean and dry. If a rash is painful or spreads, remove the patch and contact a clinician. Don’t cut the patch or place it on irritated skin.

Watch weight and eating. Small frequent meals and high-calorie snacks can help if appetite drops. If weight loss becomes noticeable over a few weeks, tell the doctor — dose change or a different treatment may be needed.

Be cautious with other meds. Drugs that slow the heart (like some beta-blockers or certain antiarrhythmics), anticholinergic medicines, or drugs that raise bleeding risk can interact with rivastigmine. Always review new medicines with the prescriber or pharmacist.

Monitor mood and behavior. Some people become more restless, confused, or see hallucinations after starting a cholinesterase inhibitor. Caregivers should note any sudden changes and report them.

When to call the doctor: repeated vomiting, fainting, new weakness, seizures, very slow pulse, or signs of bleeding. For mild side effects that don’t go away, discuss dose adjustment or switching formulation — many problems improve with small changes.

Final practical note: many patients get meaningful benefit, and side effects can often be managed. Keep a short log of symptoms, bring it to appointments, and speak up early — a small change in dose or form of Exelon can make a big difference in comfort and safety.