From the Guidelines
The starting dose of Exelon (Rivastigmine) patch is not explicitly mentioned in the provided evidence, but the starting dose of oral Rivastigmine is 1.5 mg twice daily [@\1@, @\2@].
Important Considerations
- The dosage can be increased by 1.5 mg twice daily (3 mg per day) as tolerated, but no more quickly than every four weeks, to a maximum of 6 to 12 mg per day [@\2@].
- Higher dosages are more efficacious than lower dosages, and no laboratory monitoring is required [@\2@].
- Adverse effects of Rivastigmine include nausea, vomiting, diarrhea, weight loss, headaches, dizziness, abdominal pain, fatigue, malaise, anxiety, and agitation [@\1@, @\2@].
Clinical Evidence
- Studies have shown that Rivastigmine is effective in temporarily slowing cognitive decline, improving function, and reducing behavioral and psychopathologic symptoms in patients with mild to moderate Alzheimer’s disease [@\2@, @\3@, @\4@].
- The evidence suggests that Rivastigmine has a statistically significant beneficial effect on cognitive function, but the effect on behavior and quality of life is not statistically significant [@\3@, @\4@].
- The quality of reporting harms was moderate, with commonly reported adverse effects including gastrointestinal symptoms, eating disorders/weight loss, and dizziness [@\4@].
From the Research
Starting Dose of Exelon (Rivastigmine) Patch
The starting dose of Exelon (Rivastigmine) patch is not explicitly stated in the provided studies as a specific dose for the patch formulation. However, the following information is available:
- The Exelon patch is available in three sizes: 5,10, and 15 cm(2) (releasing 4.6,9.5, and 13.3 mg rivastigmine/24 h, respectively) 1.
- The target dose for the rivastigmine patch is 9.5 mg/24 h, which is given once daily and requires a simple one-step dose titration to the therapeutic dose 2.
- For oral rivastigmine, the starting dose is 1.5 mg b.i.d. with meals, and it is increased at 2-4 week intervals to achieve the highest tolerated dose 3.
- The therapeutic dose range for oral rivastigmine is 6-12 mg/day, and it is recommended to start with a lower dose and titrate up to the target dose 3, 4, 5.
Key Points
- The Exelon patch is a transdermal formulation of rivastigmine, and its starting dose is not explicitly stated in the provided studies.
- The target dose for the rivastigmine patch is 9.5 mg/24 h, which is equivalent to the 10 cm(2) patch size.
- Oral rivastigmine has a starting dose of 1.5 mg b.i.d. and a therapeutic dose range of 6-12 mg/day.
- The dose of rivastigmine should be titrated up to the target dose to minimize adverse events and maximize efficacy.