Rivastigmine
Regulatory sources consulted
- EMA/EPAR: EMEA/H/C/001181
- AEMPS/CIMA: 198066029
- CredibleMeds.org
- AEMPS CIMA · nº registro 198066029 ↗
- EMA EPAR · EMEA/H/C/001181 ↗
- RxNorm rxcui 183379 ↗
Approved indications
- Symptomatic treatment of mild to moderately severe Alzheimer's dementia.
- Symptomatic treatment of mild to moderately severe dementia in patients with idiopathic Parkinson's disease.
Contraindications
Absolute
- Hypersensitivity to rivastigmine, other carbamate derivatives, or excipients.
- Previous history of application site reactions suggestive of allergic contact dermatitis with rivastigmine patch.
- Severe hepatic impairment.
Clinical warnings
- Major warning · Gastrointestinal disorders (nausea, vomiting, diarrhea, weight loss) are common, especially at initiation or dose increase. Can cause dehydration. — EMA
- Major warning · Risk of medication errors leading to overdose, especially with patches (confusion between starting and maintenance doses). — EMA
- Caution in patients with sick sinus syndrome, cardiac conduction defects, active peptic ulcers, asthma or COPD. — EMA
Drug interactions
- HighSuccinylcholineM03AB01
Mechanism: Pharmacodynamic synergism. Rivastigmine (cholinesterase inhibitor) potentiates the neuromuscular blocking effect of succinylcholine.
Recommendation: Avoid concomitant use. If unavoidable, be prepared for prolonged neuromuscular blockade and respiratory support during anesthesia.
EMA SPC
- ModerateAnticholinergic agents (e.g., Oxybutynin)G04BD04
Mechanism: Pharmacodynamic antagonism. Rivastigmine increases acetylcholine levels while anticholinergics block its action, potentially reducing the efficacy of both drugs.
Recommendation: Avoid concomitant use if possible, as it may reduce the therapeutic effect of rivastigmine in dementia.
EMA SPC
Adverse events
Common (≥1%)
nausea · vomiting · diarrhea · anorexia · dizziness · headache · application site reactions
Rare but serious
gastrointestinal haemorrhage · pancreatitis · seizures · severe bradycardia · atrioventricular block
Pregnancy and lactation
Pregnancy: Should not be used unless clearly necessary. Lactation: Women on rivastigmine should not breast-feed.