Rivastigmine

Treatment should be initiated and supervised by a physician experienced in the diagnosis and treatment of Alzheimer's dementia or dementia associated with Parkinson's disease, and only started if a caregiver is available to monitor intake regularly. Maintain patients on their highest well-tolerated dose. If adverse reactions occur (nausea, vomiting, abdominal pain, loss of appetite), or weight decrease, or worsening of extrapyramidal symptoms such as tremor in Parkinson's disease dementia, these may respond to omitting one or more doses; if they persist, temporarily reduce to the previous well-tolerated dose or discontinue. Re-initiation: if treatment is interrupted for more than three days, restart at 1.5 mg twice daily and re-titrate as above. Reassess clinical benefit regularly, especially below 3 mg twice a day; if after 3 months of maintenance treatment the rate of decline in dementia symptoms is not favourably altered, discontinue. Treatment effect has not been studied in placebo-controlled trials beyond 6 months. No relevant use in the paediatric population for Alzheimer's disease. This SPC is for the ORAL CAPSULE - transdermal patch dosing is not covered by the fetched label and must be sourced separately. US cross-check (verify vs UK SPC): for Parkinson's disease dementia the US label uses a minimum of 4 weeks at each dose step rather than 2 weeks, and advises careful titration and monitoring in patients weighing less than 50 kg. NOTE: the fetched eMC bundle did not include §4.5, so the interaction list below is drawn from the US label and is not a complete interaction profile.