Evecare (Rivastigmine)
Class and Category of Drug
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Chemical class: Carbamate derivative
Therapeutic class: Antidementia
Pregnancy category: B
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Drug Indications and Dosages
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To treat mild to moderate Alzheimer s-type dementia
Capsules , Oral Solution
Adults. Initial: 1.5 mg b.i.d. Dosage increased by 3 mg daily every 2 wk, as needed. Maximum: 12 mg daily.
Transdermal Adults. Initial: 4.6 mg/24 hr. After 4 wk, increased to 9.5 mg/24 hr.
To treat mild to moderate dementia in Parkinson's disease
Capsules , Oral Solution
Adults. Initial: 1.5 mg b.i.d. Dosage increased by 3 mg daily every 4 wk, as needed. Maximum: 12 mg daily.
Transdermal Adults. Initial: 4.6 mg/24 hr. After 4 wk, increased to 9.5 mg/24 hr.
To convert patient from oral to transdermal rivastigmine therapy
Transdermal Adults. If total oral dosage was less than 6 mg daily, use 4.6 mg/24 hr, with first transdermal patch applied the day after the last oral dose. If total oral dosage was 6 to 12 mg daily, use 9.5 mg/24 hr, with first transdermal patch applied the day after the last oral dose.
Dosage Adjustment
If patient develops adverse effects (such as nausea or vomiting) during oral therapy, treatment should be stopped for several doses, as prescribed, restarted at lowest dose, and increased by 3 mg daily every 2 wk, as needed. If patient develops adverse effects during transdermal therapy, treatment should be discontinnued for several days and restarted at same or next lower dose level.
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Contraindications of Drug
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Hypersensitivity to carbamate derivatives, rivastigmine, or their components
Generic Drug Interactions
Drugs
anticholinergics: Possibly decreased effectiveness of anticholinergics bethanechol, succinylcholine: Possibly syner-gistic effects
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Drugs Adverse Reactions
Central Nervous System: Aggression, anxiety, asthenia, confusion, depression, dizziness, extrapyramidal movements, fatigue, fever, hallucinations, headache, insomnia, malaise, parkinsonism, seizures, somnolence, tremor
Cardiovascular: Hypertension
Eyes, Ears, Nose, And Throat: Rhinitis
Gastrointestinal: Abdominal pain, anorexia, constipation, diarrhea, flatulence, indigestion, nausea, vomiting
Genitourinary: Urinary tract infection
Skin: Increased sweating, reaction at patch application site (pruritus, redness, swelling)
Other: Dehydration, flulike symptoms, weight loss
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Nursing Considerations for Generic Drugs
WARNING Be aware that rivastigmine should be started at lowest recommended dosage and adjusted to effective maintenance dosage because initial therapy at high dosage can cause serious adverse gastrointestinal reactions, including anorexia, nausea, and weight loss. Also, higher than recommended starting dosage may cause severe vomiting and possibly esophageal rupture. If treatment is interrupted for longer than several days, expect to restart at lowest recommended dosage.
• Be aware that drug shouldn't be stopped abruptly because doing so may increase behavioral disturbances and precipitate a further decline in cognitive function.
• Monitor respiratory status of patients with pulmonary disease, including asthma, chronic bronchitis, and emphysema, because rivastigmine has a weak affinity for peripheral cholinesterase, which may increase bronchoconstriction and bronchial secretions.
• Monitor patient for adequate urine output because cholinomimetics, such as rivastigmine, may induce or exacerbate urinary tract or bladder obstruction.
• Monitor patients with Parkinson's disease for exaggerated parkinsonian symptoms, which may result from drug's increased cholinergic effects on CNS.
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