Rivastigmine

Fetched source is the oral capsule SPC. Titration: start 1.5 mg twice a day; if well tolerated after a minimum of two weeks, increase to 3 mg twice a day; subsequent increases to 4.5 mg and then 6 mg twice a day may be considered after a minimum of two weeks at each dose level, based on good tolerability. To achieve maximum therapeutic benefit patients should be maintained on their highest well-tolerated dose. If adverse reactions (nausea, vomiting, abdominal pain, loss of appetite), weight decrease, or worsening of extrapyramidal symptoms in Parkinson's disease dementia occur, these may respond to omitting one or more doses; if they persist, reduce temporarily 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. 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. Reassess clinical benefit regularly, especially below 3 mg twice a day; discontinue if the rate of decline is not favourably altered after 3 months of maintenance treatment. Renal/hepatic: no dose adjustment for mild to moderate impairment, but titrate closely to individual tolerability due to increased exposure; severe hepatic impairment has not been studied but capsules may be used with close monitoring. Paediatric: there is no relevant use of rivastigmine in the paediatric population in the treatment of Alzheimer's disease.