Exelon Patch 5
Generic Name
Rivastigmine
Manufacturer
Novartis Pharmaceuticals Corporation
Country
Switzerland
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| exelon patch 5 46 mg patch | ৳ 179.00 | N/A |
Description
Overview of the medicine
Exelon Patch 5 is a transdermal patch containing rivastigmine, used for the treatment of mild to moderately severe Alzheimer's dementia and mild to moderate dementia associated with Parkinson's disease.
Uses & Indications
Dosage
Adults
Initial dose is one 4.6 mg/24 hours patch (Exelon Patch 5) applied once daily. The dose can be titrated upwards to 9.5 mg/24 hours (Exelon Patch 10) and then to 13.3 mg/24 hours (Exelon Patch 15) based on tolerability and efficacy, with at least 4 weeks between dose increases.
Elderly
Same as adults, but titration should be done with caution and close monitoring for adverse events.
Renal_impairment
Mild to moderate renal impairment: same as adults. Severe renal impairment: use with caution, consider a lower starting dose (e.g., oral 1.5 mg twice daily or lowest patch strength) and careful titration.
How to Take
Apply one patch once daily to clean, dry, hairless, intact skin on the upper or lower back, upper arm, or chest. Rotate application sites daily. Remove the old patch before applying a new one. Do not apply to skin that is red, irritated, or broken.
Mechanism of Action
Rivastigmine is a carbamate derivative that enhances cholinergic neurotransmission by inhibiting acetylcholinesterase and butyrylcholinesterase, thereby increasing acetylcholine concentration in the synaptic cleft.
Pharmacokinetics
Onset
Gradual onset, steady-state plasma concentrations are reached within 2-4 days of patch application.
Excretion
Mainly renal, with approximately 97% of the dose excreted in urine, largely as metabolites.
Half life
The elimination half-life of the parent drug is approximately 1 hour, but the pharmacodynamic effect lasts longer due to irreversible enzyme inhibition.
Absorption
Slow and continuous release from the patch, resulting in good bioavailability. Peak plasma concentration occurs in 8-16 hours.
Metabolism
Primarily hydrolyzed by esterases to a decarbamylated metabolite. Minimal involvement of CYP450 enzymes.
Side Effects
Contraindications
- Hypersensitivity to rivastigmine, other carbamate derivatives, or any component of the patch.
- History of application site reactions suggestive of allergic contact dermatitis (e.g., spreading erythema, blistering, severe pruritus).
Drug Interactions
Anticholinergic Agents
May interfere with the activity of anticholinergic agents.
Succinylcholine-type muscle relaxants
May exaggerate muscle relaxation during anesthesia.
Beta-blockers and other bradycardia-inducing drugs
Increased risk of bradycardia.
Storage
Store at room temperature (20-25°C or 68-77°F); excursions permitted to 15-30°C (59-86°F). Do not refrigerate or freeze. Keep in the original sealed pouch until ready to use.
Overdose
Symptoms of overdose include severe nausea, vomiting, diarrhea, sweating, bradycardia, hypotension, collapse, convulsions, muscle weakness, severe miosis. Management involves removing the patch, providing supportive care, and administering atropine if severe cholinergic symptoms occur.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. It is not known whether rivastigmine is excreted in human milk; use with caution in nursing mothers.
Side Effects
Contraindications
- Hypersensitivity to rivastigmine, other carbamate derivatives, or any component of the patch.
- History of application site reactions suggestive of allergic contact dermatitis (e.g., spreading erythema, blistering, severe pruritus).
Drug Interactions
Anticholinergic Agents
May interfere with the activity of anticholinergic agents.
Succinylcholine-type muscle relaxants
May exaggerate muscle relaxation during anesthesia.
Beta-blockers and other bradycardia-inducing drugs
Increased risk of bradycardia.
Storage
Store at room temperature (20-25°C or 68-77°F); excursions permitted to 15-30°C (59-86°F). Do not refrigerate or freeze. Keep in the original sealed pouch until ready to use.
Overdose
Symptoms of overdose include severe nausea, vomiting, diarrhea, sweating, bradycardia, hypotension, collapse, convulsions, muscle weakness, severe miosis. Management involves removing the patch, providing supportive care, and administering atropine if severe cholinergic symptoms occur.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. It is not known whether rivastigmine is excreted in human milk; use with caution in nursing mothers.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from the date of manufacture, specific to lot.
Availability
Pharmacies, Hospitals
Approval Status
FDA Approved
Patent Status
Patent expired, generics available
Clinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of rivastigmine transdermal patches in patients with mild to moderately severe Alzheimer's dementia and mild to moderate dementia associated with Parkinson's disease.
Lab Monitoring
- No specific routine laboratory monitoring is required. Monitor weight, hydration status, and cardiovascular signs, particularly during dose titration.
Doctor Notes
- Monitor patients for systemic cholinergic adverse effects (e.g., severe nausea, vomiting, diarrhea) and severe application site reactions.
- Titrate the dose slowly and cautiously to improve tolerability and maximize therapeutic benefit.
- Assess for potential drug interactions, especially with anticholinergic agents or drugs that can induce bradycardia.
Patient Guidelines
- Apply the patch to clean, dry, and hairless skin.
- Rotate application sites daily to minimize irritation.
- Remove the old patch before applying a new one after 24 hours.
- Avoid exposure to external heat sources (e.g., sunbathing, sauna, heating pads) at the application site.
- If the patch falls off, apply a new one for the remainder of the day and resume the normal schedule the next day.
Missed Dose Advice
If a dose is missed, apply a new patch as soon as remembered. Do not apply two patches to make up for a missed dose. Resume the regular application schedule the following day.
Driving Precautions
This medicine may cause dizziness or somnolence. Patients should be cautioned about operating machinery or driving until they know how the medicine affects them.
Lifestyle Advice
- Maintain a regular routine and engage in cognitive activities.
- Stay hydrated and maintain a balanced diet.
- Report any severe skin reactions or systemic side effects promptly to your doctor.
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