Rivastigmine (Exelon): What You Need to Know
Rivastigmine is a prescription medicine used mainly for mild to moderate dementia linked to Alzheimer’s disease and Parkinson’s disease. It won’t cure dementia, but it can help with thinking, memory, and daily task planning for some people. This page explains how rivastigmine works, the differences between patches and pills, common reactions, and practical tips you can use right away.
How rivastigmine works and when it's used
Rivastigmine is a cholinesterase inhibitor. That means it boosts the brain chemical acetylcholine by slowing the enzyme that breaks it down. More acetylcholine can help nerve cells communicate better, so patients may have clearer thinking or better attention for a time. Doctors usually prescribe it for mild-to-moderate Alzheimer’s dementia and for dementia related to Parkinson’s disease. Effect size varies—some people notice benefits, others see little change.
Dosing, side effects and safety tips
Rivastigmine comes as capsules (taken twice daily) and as a once-daily skin patch. Capsules often start very low and increase over weeks to reduce nausea. Common capsule doses are 1.5 mg up to 6 mg twice daily; patches are available in strength steps that deliver different micrograms per hour over 24 hours. Your doctor will pick the right form and dose based on symptoms and tolerance.
Nausea, vomiting, diarrhea, loss of appetite and weight loss are the most common side effects, especially when treatment starts or the dose goes up. Dizziness and slow heartbeat (bradycardia) can occur. Watch for fainting, severe stomach upset, or swallowing problems and tell the prescriber if these happen. If weight drops or eating becomes hard, bring it up—nutrition matters.
Practical tips: take capsules with food to reduce stomach upset. If using the patch, apply it to clean, dry, hairless skin and rotate sites daily to avoid irritation; follow the product instructions. Don’t stop rivastigmine suddenly—your doctor may taper the dose. Keep a simple log of symptoms, weight, and any side effects to share at follow-ups.
Drug interactions: tell the clinician about all medicines and supplements. Anticholinergic drugs (used for bladder, allergies or sleep) can oppose rivastigmine’s effects. Medications that slow heart rate (like some beta-blockers) may increase the chance of low heart rate. Your provider will review your meds and adjust as needed.
Questions to ask your prescriber: Which form is best for my situation—patch or pills? How will we measure improvement? What side effects should prompt a phone call or clinic visit? How often should weight and heart rate be checked? Clear answers make treatment safer and more useful.
If you’re caring for someone on rivastigmine, keep an eye on appetite, bathroom habits, fainting, and sleepiness. Small changes matter and reporting them promptly helps the care team fine-tune treatment. Always follow the prescriber’s instructions and reach out if anything feels off—early tweaks usually prevent bigger problems.
