thoughtscape NP Psychiatry · Patient education
Rivastigmine
Exelon Patch • capsules also available
Support for thinking and daily activities in certain dementias. This guide covers capsules and the daily patch.
Draft for review · Clinical content has not been revalidated for this website.
AChE and BuChE are enzymes that break down a brain messenger. Blocking them does not cure dementia.
What it is used for
For dementia caused by Alzheimer disease or Parkinson disease. The patch can also be used in severe Alzheimer dementia.
Sometimes used for dementia with Lewy bodies, which is off-label in the US. Ask what benefit your team is looking for.
How it works
Helps a brain messenger called acetylcholine stay available longer. This may support memory, thinking, and everyday tasks.
Benefits vary and may be small. This is not proof that the underlying disease has slowed or that lost abilities will return.
What to expect over time
START LOW
Your team raises the dose slowly only if you tolerate it.
EARLY CHECKS
Report poor intake, vomiting, dizziness, or more shaking.
OVER MONTHS
Compare daily abilities and treatment burden with your team.
Taking your medication
Capsules: take the prescribed dose with breakfast and the evening meal. Do not take capsules while wearing a patch.
Daily patch: remove the old one first. Apply one new patch at the same time daily to clean, dry, unbroken skin on the back, upper arm, or chest. Press for 30 seconds. No creams underneath; never cut patches.
Change spots daily; wait 14 days before reusing one. Wash hands after handling. Ask for an application demonstration.
When to get help
Call promptly: repeated vomiting or diarrhea, poor intake, weight loss, worsening tremor, or difficulty passing urine.
Remove the patch and call: a rash spreading beyond it, marked swelling, or blisters. A reaction not improving within 48 hours after removal also needs review.
Get emergency help: fainting with a slow pulse, chest pain, black stools, or bloody vomit. Call 911 for seizure, collapse, or severe breathing trouble.
Early side effects
Nausea, diarrhea, stomach upset, and poor appetite often occur during dose changes. Dizziness, headache, sweating, and sleep changes are possible. Call about persistent symptoms; do not increase through them.
Other effects to discuss
Watch weight, hydration, and balance. The patch may upset the stomach less than capsules, but it can still cause serious symptoms. Mild local redness can happen; spreading or blistering reactions are different.
What to keep track of
Your team checks pulse, weight, daily function, and side effects. Bring a dose or patch log. Blood tests or a heart tracing depend on your health history; routine drug-level testing is not needed.
Before you start
Share any history of fainting, slow heartbeat, ulcers, or bleeding, breathing disease, seizures, urinary problems, liver or kidney disease and skin allergies. Mention pregnancy or breastfeeding if relevant. Tell the surgery, dental, or MRI team about the medicine and patch before a procedure.
Medicines & interactions
Heart and movement medicines
Beta-blockers may slow the pulse further. Metoclopramide may worsen movement problems. Have these combinations checked.
Bladder, allergy, or sleep medicines
Some block acetylcholine and work against rivastigmine. Include nonprescription products on your medication list.
Pain and dementia medicines
Aspirin or NSAIDs may add bleeding risk. Do not add another cholinesterase inhibitor or combine oral rivastigmine with a patch on your own.
Everyday tips
Have one clear plan for who gives each dose.
Record patch removal and the new application site.
Keep familiar routines and safe walking areas.
Report changes in eating, drinking, and useful activities.
Your questions, answered
What if I miss a dose?
Capsule: take it when remembered unless the next dose is near; never double. Daily patch: remove any old patch and apply one new patch, then change it at the usual time the next day. After several days off, call before restarting; the dose may need to start low again.
How do I care for the patch?
If it falls off, apply a new one elsewhere and change it at your usual time. Never wear two. Avoid heating pads, saunas, and prolonged direct sun on it. Keep patches sealed until use.
What if I use too much?
Remove all patches and call Poison Control now: 1-800-222-1222, even if you feel well. Do not take more or apply a new patch until advised. Extra doses can be dangerous.
Can I stop or drive?
Discuss stopping first; the team may lower the dose and watch for worsening symptoms. Never cut patches to taper. Dementia and side effects can affect driving, so review safety with your team.
Storage & safety
Store at room temperature away from heat and moisture. Fold used patches sticky sides together, return to the pouch and discard safely away from children and pets. Used patches still contain medicine. Ask about disposal of unused supplies.
About this information
For general information only; not a substitute for individualized medical advice. This sheet does not cover every risk or interaction. Ask your prescriber or pharmacist before changing how you take this medication.
Sources
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.