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. By enhancing cholinergic function in the brain, it addresses core cognitive deficits, including memory, attention, and reasoning. This medication is available in multiple formulations—capsules, oral solution, and transdermal patches—to accommodate individual patient needs and preferences, supporting long-term adherence and therapeutic consistency under medical supervision.

Features

• Contains rivastigmine as the active pharmaceutical ingredient
• Available in oral capsules (1.5 mg, 3 mg, 4.5 mg, 6 mg), oral solution (2 mg/mL), and transdermal patches (4.6 mg/24h, 9.5 mg/24h, 13.3 mg/24h)
• Designed for once- or twice-daily dosing depending on formulation
• Transdermal patch offers continuous drug delivery over 24 hours
• FDA-approved for dementia related to Alzheimer’s and Parkinson’s diseases

Benefits

• Improves cognitive function, including memory, attention, and orientation
• Supports activities of daily living and functional independence
• May slow the progression of cognitive decline in some patients
• Enhances global functioning and behavioral symptoms
• Transdermal option reduces gastrointestinal side effects and simplifies dosing
• Provides flexibility in administration to suit patient tolerance and lifestyle

Common use

Exelon is indicated for the treatment of mild to moderate dementia of the Alzheimer’s type and dementia associated with Parkinson’s disease. It is used in patients who demonstrate cognitive impairment such as memory loss, confusion, and behavioral changes. Treatment is typically initiated and monitored by neurologists, geriatricians, or psychiatrists specializing in cognitive disorders.

Dosage and direction

Dosage must be individualized based on patient tolerance and clinical response. For oral capsules and solution: start with 1.5 mg twice daily; may increase by 1.5 mg twice daily at minimum two-week intervals to a maximum of 6 mg twice daily, if tolerated. For the transdermal patch: initiate with 4.6 mg/24h; after a minimum of four weeks, may increase to 9.5 mg/24h. If well tolerated after at least six months, may consider 13.3 mg/24h. Apply the patch to clean, dry, intact skin on the upper or lower back, upper arm, or chest; rotate application sites daily. Do not apply to red, irritated, or cut skin.

Precautions

Exelon should be used with caution in patients with a history of gastrointestinal disorders, including ulcers and bleeding, due to increased risk of nausea, vomiting, and potential weight loss. Patients with cardiac conduction abnormalities, asthma, chronic obstructive pulmonary disease, or urinary obstruction should be closely monitored. Dose escalation should be gradual to minimize cholinergic side effects. Regular weight monitoring is advised. The transdermal patch may cause skin reactions; discontinue if significant irritation occurs.

Contraindications

Exelon is contraindicated in patients with known hypersensitivity to rivastigmine, other carbamate derivatives, or any component of the formulation. It is also contraindicated in those with severe liver impairment.

Possible side effects

Common side effects include nausea, vomiting, diarrhea, loss of appetite, weight loss, dizziness, and abdominal pain. Transdermal administration may result in skin redness, itching, or rash. Less frequently, bradycardia, syncope, tremors, fatigue, and insomnia may occur. Serious but rare side effects include gastrointestinal bleeding, seizures, and extrapyramidal symptoms.

Drug interaction

Exelon may interact with other cholinergic agents (e.g., bethanechol) and anticholinergic drugs (e.g., oxybutynin, tolterodine), potentially reducing efficacy or increasing adverse effects. Concurrent use with beta-blockers or other drugs that decrease heart rate may exacerbate bradycardia. Metoclopramide may enhance extrapyramidal symptoms. Use caution with NSAIDs due to increased risk of gastrointestinal bleeding.

Missed dose

If a dose of oral Exelon is missed, administer it as soon as possible unless it is nearly time for the next dose. Do not double the dose. For the transdermal patch, apply a new patch immediately if the old one is forgotten or detached; then continue on the original schedule.

Overdose

Overdose may lead to severe nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, seizures, and loss of consciousness. Suspected overdose requires immediate medical attention. Treatment is supportive and may include administration of anticholinergic agents such as atropine.

Storage

Store Exelon capsules and oral solution at room temperature (15–30°C or 59–86°F). Keep the oral solution bottle tightly closed and upright. Store transdermal patches in their sealed pouch at room temperature. Keep all formulations 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 any medication regimen. Individual patient needs and responses may vary.

Reviews

Clinical studies and patient reports indicate that Exelon can provide meaningful cognitive and functional benefits in appropriately selected individuals. Many caregivers note improved engagement and reduced behavioral symptoms. Gastrointestinal side effects are a common reason for discontinuation in oral forms, though the transdermal patch is often better tolerated. Adherence to dose titration schedules is critical for maximizing tolerability and efficacy.