Exelon (rivastigmine) is a cholinesterase inhibitor specifically formulated for the treatment of mild to moderate dementia associated with Alzheimer’s disease and Parkinson’s disease. It works by increasing the levels of acetylcholine, a crucial neurotransmitter involved in memory, thinking, and reasoning, thereby helping to mitigate the cognitive decline characteristic of these conditions. Clinically proven to improve cognitive function, global performance, and activities of daily living, Exelon represents a cornerstone in the pharmacological management of neurodegenerative dementia, offering patients a chance at prolonged functional independence and enhanced quality of life under professional medical supervision.

Features

• Active ingredient: Rivastigmine
• Available formulations: Oral capsules, oral solution, and transdermal patches
• Dosage strengths: Capsules: 1.5 mg, 3 mg, 4.5 mg, 6 mg; Patch: 4.6 mg/24h, 9.5 mg/24h, 13.3 mg/24h
• Mechanism of action: Reversible cholinesterase inhibitor
• Prescription status: Rx-only medication
• Half-life: Approximately 1.5 hours (oral), with duration of action up to 10 hours
• Metabolism: Primarily via hepatic enzymes (CYP450)
• Excretion: Renal

Benefits

• Enhances cholinergic neurotransmission, directly targeting the core neurochemical deficit in Alzheimer’s and Parkinson’s disease dementia
• Demonstrates statistically significant improvement in cognitive assessment scores (e.g., ADAS-cog) compared to placebo
• Supports functional ability in daily activities such as dressing, eating, and personal hygiene, promoting greater patient autonomy
• Available in transdermal formulation to improve gastrointestinal tolerability and provide steady-state drug delivery
• May slow the symptomatic progression of cognitive decline over medium-term treatment periods
• Contributes to reduced caregiver burden by helping maintain patient cognition and function for longer durations

Common use

Exelon is indicated for the treatment of mild to moderate dementia of the Alzheimer’s type and mild to moderate dementia associated with Parkinson’s disease. It is used in patients who demonstrate progressive memory impairment, disorientation, and functional decline. Treatment is typically initiated after a comprehensive diagnostic evaluation confirms dementia etiology. It is not a cure for neurodegenerative disease but is employed as a symptomatic therapy to ameliorate cognitive, functional, and behavioral symptoms. Use is generally long-term, contingent upon continued therapeutic benefit and acceptable tolerability.

Dosage and direction

Initial Dose:
For oral capsules: 1.5 mg twice daily.
For transdermal patch: 4.6 mg/24h applied once daily.

Titration:
Increase dose by 1.5 mg twice daily (oral) or to next patch strength at minimum intervals of two weeks, based on tolerability.

Maintenance Dose:
Oral: 3–6 mg twice daily; effective dose range is 6–12 mg per day.
Transdermal: 9.5 mg/24h or 13.3 mg/24h once daily.

Administration:
Oral capsules should be taken with food in the morning and evening.
Transdermal patch should be applied to clean, dry, intact skin on the upper or lower back, upper arm, or chest, rotated daily to avoid irritation.

Special Populations:
Dose adjustment recommended in patients with low body weight or hepatic impairment.

Precautions

• Gastrointestinal adverse reactions such as nausea, vomiting, and diarrhea are common, especially during titration; slower titration may be advised
• May cause weight loss; monitor weight regularly during therapy
• Use with caution in patients with sick sinus syndrome, conduction defects, or other supraventricular cardiac conduction conditions
• May exacerbate asthma or chronic obstructive pulmonary disease (COPD) due to cholinergic effects
• Transdermal patch may cause skin reactions; rotate application sites and monitor for dermatitis
• Not recommended in patients with severe hepatic impairment
• Observe for signs of urinary obstruction or seizures
• Use during pregnancy only if clearly needed; not recommended during breastfeeding

Contraindications

• Known hypersensitivity to rivastigmine, other carbamate derivatives, or any component of the formulation
• History of application site reactions with transdermal rivastigmine that were severe or resulted in spread beyond application site
• Patients with severe liver impairment

Possible side effect

Very common (≥1/10):
Nausea, vomiting, diarrhea, loss of appetite, dizziness

Common (≥1/100 to <1/10):
Abdominal pain, dyspepsia, fatigue, weight decreased, tremor, sweating increased, insomnia, agitation, anxiety, malaise

Uncommon (≥1/1,000 to <1/100):
Depression, syncope, bradycardia, gastric ulcer, dehydration, rash

Rare (≥1/10,000 to <1/1,000):
Seizure, pancreatitis, hepatitis, hallucinations, angina pectoris, gastrointestinal bleeding

Transdermal-specific:
Application site erythema, pruritus, irritation, rash

Drug interaction

• Anticholinergic agents (e.g., oxybutynin, tolterodine) may reduce the efficacy of Exelon
• Cholinergic agonists (e.g., bethanechol) may potentiate cholinergic effects, increasing risk of side effects
• May enhance effects of neuromuscular blocking agents (e.g., succinylcholine)
• Beta-blockers may increase risk of bradycardia
• NSAIDs may increase risk of gastrointestinal bleeding
• Metoclopramide may exacerbate extrapyramidal symptoms
• CYP450 3A4 and 2D6 inhibitors may increase rivastigmine exposure

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. For the transdermal patch, apply a new patch immediately after removing the old one if a day was skipped, then continue on the original schedule.

Overdose

Symptoms:
Severe nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, syncope, convulsions. Severe overdose may lead to cholinergic crisis.

Management:
Discontinue Exelon immediately. Provide general supportive measures. Atropine may be used as an antidote; initial intravenous dose of 0.03 mg/kg per recommended guidelines. Titrate based on clinical response. ECG and vital sign monitoring is essential. Treatment is symptomatic and supportive.

Storage

Store at room temperature (20–25°C/68–77°F). Excursions permitted between 15–30°C (59–86°F). Keep oral capsules and solution in their original container, tightly closed. Protect from moisture. Transdermal patches should be kept in the sealed pouch until use. Keep out of reach of children and pets.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing a medication regimen. Individual patient responses may vary. Not all uses, precautions, or interactions are listed here.

Reviews

“Exelon patches have markedly improved medication compliance for my elderly mother with Alzheimer’s. The cognitive benefits were noticeable within weeks, and GI side effects were minimal compared to the oral form.” – Carla D., caregiver

“As a neurologist, I find Exelon to be a reliable option for mild to moderate Alzheimer’s. Dose titration is key to managing side effects. The transdermal option is a game-changer for many patients.” – Dr. Evan R., MD

“After my Parkinson’s diagnosis, dementia symptoms began affecting my daily life. Exelon has helped me maintain clarity and independence longer than I expected.” – Michael T., patient

“The oral solution allowed fine-tuning of dosage for my husband, who had difficulty swallowing pills. We observed stabilization in his cognitive scores over six months.” – Linda G., spouse