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Dual AChEI and BuChEI inhibitor — dementia

Rivastigmine

Brand names: Exelon

Used in: Delirium & Cognitive Impairment

Rivastigmine is a cholinesterase inhibitor used for the symptoms of Alzheimer's disease and Parkinson's disease dementia; it comes as capsules and a transdermal patch.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Alzheimer’s Disease (2.1): Initial Dose: Initiate treatment with 1.5 mg twice a day. Dose Titration: After a minimum of 2 weeks, if tolerated, increase dose to 3 mg twice a day and further to 4.5 mg twice a day and 6 mg twice a day if tolerated with a minimum of 2 weeks at each dose Parkinson’s Disease Dementia (PDD) (2.2): Initial Dose: Initiate treatment with 1.5 mg twice a day. Dose Titration: After a minimum of 4 weeks, if tolerated, increase dose to 3 mg twice a day and further to 4.5 mg twice a day and 6 mg twice a day if tolerated with a minimum of 4 weeks at each dose. Rivastigmine tartrate capsules should be taken with meals in divided doses in the morning and evening (2.1, 2.2). …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2022-03-21. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It inhibits acetylcholinesterase (and butyrylcholinesterase), increasing acetylcholine to support cognition; it eases symptoms rather than modifying the disease.

Prescribing in practice

  • Cholinergic effects (nausea, vomiting, diarrhoea, weight loss, bradycardia) occur — titrate slowly; the patch can improve gastrointestinal tolerance.
  • Use caution in cardiac conduction problems, active peptic ulcer disease and significant airways disease.
  • With the patch, remove the old one before applying a new one — serious overdose has occurred from wearing multiple patches.

Monitoring

Review cognition and function, heart rate, weight and gastrointestinal tolerance.

Counselling the patient

  • Nausea or appetite loss can occur, especially when increasing the dose.
  • With patches, remove the old patch before applying a new one and rotate sites.
  • Report fainting, a slow pulse or significant weight loss.

Evidence & guidelines

Recommended for Alzheimer's disease and Parkinson's disease dementia per NICE NG97/TA217.

Reference: NICE TA217; NICE NG97; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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