Medically reviewed on December 1, Exelon should be taken with meals in divided doses in the morning and conotative and denotative lesson plans. There is evidence from the clinical trials that doses at the higher end of this range may be more beneficial.
After a minimum of 2 weeks and if well tolerated, increase the dose to 3 mg twice a day. Subsequent increases to 4, brian spencer and exelon. The maximum dose is 6 mg twice a day 12 brian spencer and exelon per day. After a minimum of 4 weeks and if well tolerated, increase the dose to 3 mg twice a day.
If adverse effects e. If dosing is interrupted for 3 days or fewer, restart treatment with the same or lower dose of Exelon. If dosing is interrupted for more than 3 days, treatment should be restarted with 1. Dosing Modifications in Patients with Renal Impairment. Patients with mild Child-Pugh score 5 to 6 and moderate Child-Pugh score 7 to 9 hepatic impairment may be able to only tolerate lower doses.
No data are available on the use of rivastigmine in patients with severe hepatic impairment. Carefully titrate and monitor patients with low body weight less than 50 kg for toxicities e. Caregivers should be instructed in the correct procedure for administering Brian spencer and exelon Oral Solution, brian spencer and exelon. In addition, they should be directed to the Instruction Sheet included with the product describing how the solution is to be administered.
Caregivers should direct questions about the administration of the solution to either their physician or pharmacist [see Patient Counseling Information 17 ].
Patients should be instructed to remove the oral dosing syringe provided in its protective case, and using the provided syringe, withdraw the prescribed amount of Exelon Oral Solution from the container. Each dose of Exelon Oral Solution may be swallowed directly from the syringe or first mixed with a small glass of water, cold fruit juice, or soda. Patients should be instructed to stir and drink the mixture. Isolated cases of generalized skin reactions have been described in postmarketing experience [see Adverse Reactions 6.
Dehydration may result from prolonged vomiting or diarrhea and can be associated with serious outcomes. The incidence and severity of these reactions are dose-related [see Adverse Reactions 6. For this reason, patients should always be started at a dose of 1. If treatment is interrupted for longer than 3 days, treatment should be reinitiated with the lowest daily dose [see Dosage and Administration 2. Inform caregivers to monitor for gastrointestinal adverse reactions and to inform the physician if they occur.
It is critical to inform caregivers that if therapy has been interrupted for more than 3 days because of intolerance, the next dose should not be administered without contacting the physician regarding proper retitration, brian spencer and exelon. There have been isolated postmarketing reports of patients experiencing disseminated allergic dermatitis when administered rivastigmine irrespective of the route of administration oral or transdermal.
Treatment should be discontinued if disseminated allergic dermatitis occurs [see Contraindications 4 ]. Patients and caregivers should be instructed accordingly [see Patient Counseling Information 17 ]. In patients who develop application site reactions suggestive of allergic contact dermatitis to Exelon PATCH and who still require rivastigmine, treatment should be switched to oral rivastigmine only after negative allergy testing and under close medical supervision.
It is possible that some patients sensitized to rivastigmine by exposure to rivastigmine patch may not be able to take rivastigmine in any form, brian spencer and exelon.
Cholinomimetics, including rivastigmine may exacerbate or induce extrapyramidal symptoms. Drugs that increase cholinergic activity are believed to have some potential for causing seizures.
Cholinesterase inhibitors, including rivastigmine, may be expected to increase gastric acid secretion due to increased cholinergic activity. Monitor patients using Exelon for symptoms of active or occult gastrointestinal bleeding, especially those at increased risk for developing ulcers, e, brian spencer and exelon. Clinical studies of rivastigmine have shown no significant increase, relative to placebo, in the incidence of either peptic ulcer disease biotin and diabetes gastrointestinal bleeding.
Rivastigmine, as a cholinesterase inhibitor, is likely to exaggerate succinylcholine-type muscle relaxation during anesthesia. Because rivastigmine increases cholinergic activity, use of rivastigmine may have vagotonic effects on heart rate e.
The potential for this action may be particularly important in patients with sick sinus syndrome or other supraventricular cardiac conduction conditions. In clinical trials, rivastigmine was not associated with any increased incidence of cardiovascular adverse events, heart rate or blood pressure changes, or electrocardiogram ECG abnormalities. Although not observed in clinical trials of rivastigmine, drugs that increase cholinergic activity may cause urinary obstruction.
Drugs that increase cholinergic activity, including rivastigmine, should be used with care in patients with a history of asthma or obstructive pulmonary disease.
Dementia may cause gradual impairment of driving performance or compromise the ability to use machinery. Brian spencer and exelon administration of rivastigmine may also result in adverse reactions that are detrimental to these functions.
The following adverse reactions are described below and elsewhere in the labeling: Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Exelon has been administered to over 5, individuals during clinical trials worldwide. Of these, 4, patients have been treated for at least 3 months, 3, patients have been treated for at least 6 months, 2, patients have been treated for 1 year, 1, patients have been treated for 2 years, and patients have been treated for over 3 years.
With regard to exposure to the highest dose, 2, patients were exposed to doses of 10 mg to 12 mg, 2, patients treated for 3 months, 2, patients treated for 6 months, 1, patients treated for 1 year, patients treated for 2 years, and patients treated for over 3 years. These include nausea, vomiting, anorexia, brian spencer and exelon, dyspepsia, and asthenia. Exelon use is associated with significant nausea, vomiting, and weight loss [ see Warnings and Precautions 5.
No systematic effect of race or age could be determined from the incidence of adverse reactions in the controlled studies. Nausea, vomiting and weight loss were more frequent in women than men, brian spencer and exelon. The rates were higher in women than men.
It is not clear how much of the weight loss was associated with anorexia, nausea, vomiting, and the diarrhea associated with the drug. Neither the time course nor the severity of the brian spencer and exelon is known. Exelon has been administered to individuals during clinical animation lesson plan and middle school worldwide.
Of these, patients have been treated for at least 3 months, patients have been treated for at least 6 months, and patients have been brian spencer and exelon for 1 year. These include nausea, vomiting, tremor, anorexia, and dizziness. The following adverse reactions have been identified during post approval use of Exelon Capsules, Exelon Oral Solution, or Exelon Patch.
Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Skin and Subcutaneous Tissue Disorders: Allergic dermatitis, application site hypersensitivity patchblister, brian spencer and exelon, disseminated allergic dermatitis, Stevens-Johnson syndrome, urticaria.
Due to the risk of additive extrapyramidal adverse reactions, the concomitant use of metoclopramide and Exelon brian spencer and exelon not recommended. Exelon may increase the cholinergic effects of other cholinomimetic medications and may also interfere with the activity of anticholinergic medications e.
Concomitant use of Exelon with medications having these pharmacologic effects is not recommended unless deemed clinically necessary [see Warnings and Precautions 5. Additive bradycardic effects resulting in syncope may occur when Exelon is used concomitantly with beta-blockers, especially cardioselective beta-blockers including atenolol.
Concomitant use of Exelon with beta-blockers is not recommended. There are no adequate and well-controlled studies in pregnant women. Reproduction studies conducted in pregnant rats and rabbits at oral doses up to brian spencer and exelon. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Rivastigmine and its metabolites are excreted in rat milk following oral administration of rivastigmine; levels of rivastigmine plus metabolites in rat milk are approximately 2 times that in maternal plasma.
It is brian spencer and exelon known whether rivastigmine is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Exelon, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Safety and effectiveness in pediatric patients have not been established. The use of Exelon in pediatric patients below 18 years of age is not recommended.
No overall differences in safety or effectiveness were observed between these patients and younger patients, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.
Patients with moderate to severe renal impairment may be able to only tolerate lower doses [see Dosage and Administration 2. Patients with mild or moderate hepatic impairment may be able to only tolerate lower doses [see Dosage and Administration 2.
No data are available on the use of Exelon in patients with severe hepatic impairment. Because rivastigmine blood levels vary with weight, careful titration and monitoring should be performed in patients with low or high body weights [see Dosage and Administration 2. Because strategies for the management of overdose are continually evolving, it is advisable to contact a Poison Control Center to determine the latest recommendations for the management brian spencer and exelon an overdose of any drug.
As rivastigmine has a short plasma half-life of about 1 hour and a moderate duration of acetylcholinesterase inhibition of 8 to 10 hours, brian spencer and exelon is recommended that in cases of asymptomatic overdoses, no further dose of Exelon should be administered for the next 24 hours. As in any case of brian spencer and exelon, general supportive measures should be utilized. Overdosage with cholinesterase inhibitors can result in cholinergic crisis characterized by severe nausea, vomiting, salivation, sweating, bradycardia, brian spencer and exelon, hypotension, respiratory depression, collapse and convulsions.
Increasing muscle weakness is a possibility and may result in death if respiratory muscles are involved. Atypical responses in blood pressure and heart rate have been reported with other drugs that increase cholinergic activity when coadministered with quaternary anticholinergics such as glycopyrrolate.
Additional symptoms associated with rivastigmine overdose are diarrhea, abdominal pain, dizziness, tremor, headache, somnolence, confusional state, hyperhidrosis, hypertension, hallucinations and malaise.
Due to the short half-life of rivastigmine, dialysis hemodialysis, peritoneal dialysis, or hemofiltration would not be clinically indicated in the event of an overdose. In overdoses accompanied by severe nausea and vomiting, the use of antiemetics should be considered. A fatal outcome has been rarely reported with rivastigmine, brian spencer and exelon.
Exelon rivastigmine tartrate is a reversible cholinesterase inhibitor and is known chemically as S -N-Ethyl-N-methyl[1- dimethylamino ethyl]-phenyl carbamate hydrogen- 2R,3R -tartrate.
Rivastigmine tartrate is a white to brian spencer and exelon, fine crystalline powder that is very soluble in water, soluble in ethanol and acetonitrile, brian spencer and exelon, slightly soluble in n-octanol and very slightly soluble in ethyl acetate. Exelon Capsules contain rivastigmine tartrate, equivalent to 1. Inactive ingredients are hydroxypropyl methylcellulose, clomid and high prolactin patients stearate, microcrystalline cellulose, and silicon dioxide.
Although the precise mechanism of action of rivastigmine is unknown, it is thought to exert its therapeutic effect by enhancing cholinergic function. This is accomplished by increasing the concentration of acetylcholine through reversible inhibition of its hydrolysis by cholinesterase.
Therefore, the effect of rivastigmine may lessen as the disease process advances and fewer cholinergic neurons remain functionally intact.