Exelon (Rivastigmine Tartrate)

(ri va stig' meen)

Rivastigmine transdermal patches are used to treat dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and may cause changes in mood and personality) in people with Alzheimer's disease (a brain disease that slowly destroys the memory and the ability to think, learn, communicate and handle daily activities). Transdermal rivastigmine is also used to treat dementia in people with Parkinson's disease (a brain system disease with symptoms of slowing of movement, muscle weakness, shuffling walk, and loss of memory). Rivastigmine is in a class of medications called cholinesterase inhibitors. It improves mental function (such as memory and thinking) by increasing the amount of a certain natural substance in the brain.

Transdermal rivastigmine comes as a patch you apply to the skin. It is usually applied once a day. Apply the rivastigmine patch at around the same time each day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use the rivastigmine skin patch exactly as directed. Do not apply it more or less often than prescribed by your doctor. Your doctor will probably start you on a low dose of rivastigmine and gradually increase your dose, not more often than once every 4 weeks. Transdermal rivastigmine may improve the ability to think and remember or slow the loss of these abilities, but it does not cure Alzheimer's disease or dementia in people with Parkinson's disease. Continue to use transdermal rivastigmine even if you feel well. Do not skip using transdermal rivastigmine without talking to your doctor. Apply the patch to clean, dry skin that is relatively free of hair (upper or lower back or upper arm or chest). Do not apply the patch to an open wound or cut, to skin that is irritated, red, or to skin that is affected by a rash or other skin problem. Do not apply the patch to a place that would be rubbed against by tight clothing. Select a different area each day to avoid skin irritation. Be sure to remove the patch before you apply another one. Do not apply a patch to the same spot for at least 14 days. If the patch loosens or falls off, replace it with a new patch. However, you should remove the new patch at the time that you were scheduled to remove the original patch. While you are wearing a rivastigmine patch, protect the patch from direct heat such as heating pads, electric blankets, heat lamps, saunas, hot tubs, and heated water beds. Do not expose the patch to direct sunlight for very long. To apply the patch, follow these steps:

• Choose the area where you will apply the patch. Wash the area with soap and warm water. Rinse off all of the soap and dry the area with a clean towel. Be sure the skin is free of powders, oil, and lotions.
• Select a patch in a sealed pouch and cut open the pouch open with scissors. Be careful not to cut the patch.
• Remove the patch from the pouch and hold it with the protective liner facing you.
• Peel the liner off one side of the patch. Be careful not to touch the sticky side with your fingers. A second strip of liner should remain stuck to the patch.
• Press the patch firmly onto your skin with the sticky side down.
• Remove the second strip of protective liner and press the rest of the sticky side of the patch firmly against your skin. Be sure that the patch is pressed flat against the skin with no bumps or folds and the edges are firmly attached to the skin.
• Wash your hands with soap and water after you handle the patch.
• After you have worn the patch for 24 hours, use your fingers to peel the patch off slowly and gently. Fold the patch in half with the sticky sides together and dispose of it safely, out of reach of children and pets.
• Apply a new patch to a different area immediately by following steps 1 to 8.

Before using transdermal rivastigmine,
• tell your doctor and pharmacist if you are allergic to rivastigmine, neostigmine (Prostigmin), physostigmine (Antilirium, Isopto Eserine), pyridostigmine (Mestinon, Regonol), or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antihistamines; bethanechol (Duvoid, Urecholine); ipratropium (Atrovent); and medications for Alzheimer's disease, glaucoma, irritable bowel disease, motion sickness, myasthenia gravis, Parkinson's disease, ulcers, or urinary problems.
• tell your doctor if you have or have ever had asthma, an enlarged prostate or other condition that blocks the flow of urine, ulcers, abnormal heart beats, seizures, uncontrollable shaking of a part of the body, other heart or lung disease, or kidney or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using transdermal rivastigmine, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using transdermal rivastigmine.

Unless your doctor tells you otherwise, continue your normal diet.

Apply the missed patch as soon as you remember it. However, you should still remove the patch at your regular patch removal time. If it is almost time for the next patch, skip the missed patch and continue your regular dosing schedule. Do not apply extra patches to make up for a missed dose.

Transdermal rivastigmine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• diarrhea
• loss of appetite
• stomach pain
• weight loss
• depression
• headache
• anxiety
• dizziness
• weakness
• excessive tiredness
• difficulty falling asleep or staying asleep.
• tremor or worsening tremor

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• black and tarry stools
• red blood in stools
• bloody vomit
• vomiting material that looks like coffee grounds
• difficulty urinating
• painful urination
• seizures

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Dispose of any patches that are outdated or no longer needed by opening each pouch, folding each patch in half with the sticky sides together. Place the folded patch in the original pouch and dispose of it safely, out of the reach of children and pets. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Keep all appointments with your doctor. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.