Exelon (rivastigmine) is a prescription medication specifically formulated to address the cognitive decline associated with mild to moderate dementia in Alzheimer’s and Parkinson’s diseases. As a cholinesterase inhibitor, it works by increasing levels of acetylcholine, a crucial neurotransmitter involved in memory, thinking, and reasoning. Clinical evidence supports its role in slowing symptom progression, helping patients maintain functional abilities longer. This medication is available in multiple formulations—including capsules, oral solution, and transdermal patches—to accommodate individual patient needs and preferences.

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)
• Dual inhibition of acetylcholinesterase and butyrylcholinesterase
• Transdermal formulation offers continuous 24-hour delivery
• Manufactured under strict pharmaceutical quality controls

Benefits

• Helps slow the progression of memory loss and cognitive impairment in Alzheimer’s and Parkinson’s dementia
• May improve or maintain activities of daily living, supporting greater patient independence
• Can enhance attention, concentration, and organizational abilities
• Transdermal patch option reduces gastrointestinal side effects and improves adherence
• Provides flexible dosing options to accommodate individual tolerance and response

Common use

Exelon is indicated for the treatment of mild to moderate dementia associated with Alzheimer’s disease and Parkinson’s disease. It is used to address core cognitive symptoms including memory impairment, disorientation, and difficulties with reasoning and judgment. The medication may also help with behavioral symptoms and functional decline. Treatment is typically initiated in the early stages of dementia when patients still retain some functional abilities. Therapy is considered long-term, with regular assessment of benefits versus side effects.

Dosage and direction

Initial dosing: Oral therapy typically begins with 1.5 mg twice daily, with increases to 3 mg, 4.5 mg, and 6 mg twice daily at minimum 2-week intervals based on tolerability. Transdermal patch therapy starts with 4.6 mg/24h, with potential escalation to 9.5 mg/24h after minimum 4 weeks, and to 13.3 mg/24h after additional 4 weeks if well-tolerated.

Administration: Oral capsules should be taken with food in the morning and evening. The oral solution can be taken directly or mixed with water, juice, or soda. Transdermal patches should be applied to clean, dry, intact skin on the upper or lower back, upper arm, or chest, rotating application sites daily. Patches should be replaced every 24 hours.

Special populations: Lower starting doses and slower titration are recommended for patients with low body weight or those experiencing significant side effects. Hepatic impairment requires careful dose adjustment.

Precautions

Patients should be monitored for gastrointestinal effects including nausea, vomiting, and weight loss. Those with respiratory conditions should use caution due to potential increased bronchial secretions. Exelon may cause bradycardia and syncope, particularly in patients with cardiac conduction abnormalities. Seizure risk may be increased in susceptible individuals. Transdermal patches may cause skin reactions at application sites. Patients should be advised about potential dizziness and cautioned regarding activities requiring mental alertness.

Contraindications

Exelon is contraindicated in patients with known hypersensitivity to rivastigmine, other carbamate derivatives, or any component of the formulation. The transdermal patch is contraindicated in patients with known latex allergy. Patients with severe liver impairment should not use this medication. Those with a history of application site reactions with previous transdermal rivastigmine use should avoid the patch formulation.

Possible side effects

Very common (>10%): Nausea, vomiting, diarrhea, loss of appetite, weight decrease, dizziness Common (1-10%): Abdominal pain, dyspepsia, fatigue, weakness, tremor, sweating, anxiety, depression, insomnia Uncommon (0.1-1%): Gastric ulcer, syncope, bradycardia, atrial fibrillation, urinary tract infection Rare (<0.1%): Pancreatitis, seizures, extrapyramidal symptoms, hepatic enzyme increases Transdermal-specific: Skin reactions including erythema, pruritus, irritation at application site

Drug interaction

Exelon may potentiate effects of other cholinergic drugs and antagonize effects of anticholinergic medications. It may enhance the neuromuscular blocking effects of succinylcholine-type agents during anesthesia. Concurrent use with beta-blockers may increase the risk of bradycardia. Metabolized mainly through hydrolysis, it has minimal cytochrome P450 interactions, but caution is advised with drugs that significantly affect this enzyme system.

Missed dose

If a dose of oral medication is missed, it should be skipped and the next dose taken at the regular time. Doubling doses is not recommended. For transdermal patches, if a patch is forgotten, a new patch should be applied as soon as remembered, then continue with the next patch at the regular change time. Do not apply extra patches to make up for missed doses.

Overdose

Symptoms may include severe nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, and convulsions. Increasing muscle weakness may occur and can result in death if respiratory muscles are involved. Treatment involves general supportive measures. Atropine sulfate may be used as an antidote, with initial intravenous doses of 0.03 mg/kg and titration based on clinical response.

Storage

Store at room temperature (15-30°C or 59-86°F). Oral solution should be kept in the original container and used within 30 days of opening. Transdermal patches should remain in their sealed pouch until use. Keep all formulations out of reach of children and protected from moisture. Do not freeze the oral solution. Dispose of used patches by folding adhesive sides together and discarding in household trash.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Exelon is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to treatment may vary. Patients should consult their physician for proper diagnosis, treatment recommendations, and monitoring. Never adjust dosage or discontinue medication without medical guidance.

Reviews

Clinical studies demonstrate that Exelon provides statistically significant benefits in cognitive function, activities of daily living, and global functioning compared to placebo. Many clinicians report observed stabilization or modest improvement in cognitive symptoms in appropriate patients. Caregivers often note improved engagement and maintained functional abilities. The transdermal formulation is frequently cited as offering improved tolerability and convenience compared to oral administration. Long-term treatment benefits appear most significant when initiated early in the disease course and maintained with regular monitoring.