Rivas 1.5 Capsule

Cholinesterase inhibitor for:

• Mild to moderately severe Alzheimer's dementia (symptomatic improvement)
• Mild to moderate dementia in Parkinson's disease

Capsules/solution: start 1.5 mg twice daily with morning and evening meals; increase by 1.5 mg twice daily at intervals of at least 2 weeks, to 3–6 mg twice daily (maximum 6 mg twice daily).

Patch: start 4.6 mg/24 h, increase after at least 4 weeks to 9.5 mg/24 h (maximum 13.3 mg/24 h); apply a new patch daily to clean, hairless skin on the back/upper arm/chest, rotating sites.

• If doses are missed for more than 3 days, restart at the lowest dose.
• Take capsules with food to reduce nausea.

• Allergy to rivastigmine or carbamates
• Previous severe skin reaction to the patch

Very common: nausea, vomiting, loss of appetite, weight loss, dizziness, diarrhoea.

Common: headache, tiredness, tremor or worsening Parkinson's symptoms, insomnia, agitation, sweating; patch: skin redness/itching.

Serious: slow heartbeat, fainting, heart block, gastrointestinal bleeding, seizures, severe vomiting with dehydration.

• Heart rhythm problems (sick sinus, conduction defects), peptic ulcer, asthma/COPD, urinary obstruction, seizures: caution.
• Monitor weight.
• Patch: remove the old patch before applying a new one — never wear more than one (overdose risk).

Not usually relevant; use only if clearly needed. Avoid breastfeeding.

• Beta-blockers, digoxin, amiodarone, diltiazem/verapamil (slow heart rate)
• Anticholinergic drugs (oxybutynin, tricyclics — oppose effect)
• Metoclopramide (more Parkinsonian symptoms)
• Suxamethonium (prolonged muscle relaxation in anaesthesia)

Severe nausea, vomiting, diarrhoea, sweating, slow heartbeat, low blood pressure, muscle weakness, seizures. Remove patches; emergency care (atropine).

Store below 30°C. Patches: keep in the sealed sachet until use.