Stahl's Essential Psychopharmacology Online
In Collaboration With
Rivastigmine
Therapeutics
Brands
• Exelon, Prometax
Generic?
No
Class
• Cholinesterase inhibitor
Commonly Prescribed for
(FDA approved in bold)
• Alzheimer dementia (AD) (mild or moderate)
• Dementia associated with Parkinson's Disease (PD)
• Dementia with Lewy Bodies (DLB)
• Vascular dementia
How the Drug Works
• Increases
the concentration of acetylcholine through reversible inhibition of
acetylcholinesterase, which increases availability
of acetylcholine. Also inhibits
butyrylcholinesterase. A deficiency of cholinergic function is felt to
be important in producing
the signs and symptoms of AD. May
interfere with amyloid deposition
• Although symptoms of AD can improve, rivastigmine does not prevent disease progression
How Long Until It Works
• Typically 2-6 weeks at a given dose, but effect is best observed over a period of months
If It Works
• Continue to use but symptoms of dementia usually continue to worsen
If It Doesn't Work
• Non-pharmacologic measures are the basis of dementia treatment. Maintain regular schedules and routines. Avoid prolonged travel,
unnecessary medical procedures or emergency room visits, crowds, and large social gatherings
• Limit drugs with sedative properties such as opioids, hypnotics, antiepileptic drugs and tricyclic antidepressants
• Treat other disorders which can worsen symptoms such as hyperglycemia or urinary difficulties
Best Augmenting Combos for Partial Response or Treatment-Resistance
• Addition of the NMDA receptor antagonist memantine may be beneficial
• Treat
depression or apathy, if present, with SSRIs. Avoid tricyclic
antidepressants in demented patients due to risk of confusion
• For
significant confusion and agitation avoid typical neuroleptics
(especially in DLB) because of the risk of neuroleptic
malignant syndrome. Atypical
antipsychotics (risperidone, quetiapine, olanzapine, clozapine) can be
used instead
Tests
• None required