Rivadem
Generic Name
Rivastigmine
Manufacturer
Healthcare Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| rivadem 15 mg capsule | ৳ 23.00 | ৳ 230.00 |
Description
Overview of the medicine
Rivadem 15 mg capsule contains Rivastigmine, a cholinesterase inhibitor used to treat mild to moderately severe Alzheimer's disease dementia and mild to moderately severe dementia associated with Parkinson's disease.
Uses & Indications
Dosage
Adults
Initial dose: 1.5 mg twice daily with meals. Dosage may be increased to 3 mg twice daily after at least two weeks, and further to 4.5 mg twice daily, and then 6 mg twice daily (maximum oral dose 12 mg/day) if tolerated. A 15 mg capsule typically suggests a once-daily extended-release formulation or a total daily dose for established patients, possibly administered as 7.5 mg twice daily if immediate release, under strict medical supervision.
Elderly
Similar to adults, but dose titration should be done carefully, monitoring for tolerability and adverse effects.
Renal_impairment
No dose adjustment is usually required for mild to moderate renal impairment. For severe renal impairment, dose adjustment may be necessary, and caution is advised.
How to Take
Rivadem capsules should be taken orally twice daily, preferably with morning and evening meals, to reduce gastrointestinal side effects. Swallow the capsule whole with water.
Mechanism of Action
Rivastigmine works by inhibiting acetylcholinesterase and butyrylcholinesterase, leading to increased concentrations of acetylcholine in the synaptic clefts in the central nervous system. This enhances cholinergic neurotransmission.
Pharmacokinetics
Onset
Therapeutic effects are typically observed after several weeks to months of continuous treatment.
Excretion
Excreted predominantly via the urine (approximately 97% of the dose) as metabolites, with less than 1% excreted unchanged in urine.
Half life
Plasma elimination half-life is approximately 1 hour, but the pharmacological effect (cholinesterase inhibition) lasts longer (up to 9 hours).
Absorption
Rapidly and completely absorbed orally, peak plasma concentrations reached in approximately 1 hour. Food delays absorption and decreases Cmax but does not significantly affect AUC.
Metabolism
Extensively metabolized, primarily via cholinesterase-mediated hydrolysis to its main decarbamylated metabolite. Metabolism is largely independent of cytochrome P450 isoenzymes.
Side Effects
Contraindications
- Hypersensitivity to rivastigmine, other carbamate derivatives, or any excipients in the formulation.
- History of severe adverse skin reactions with rivastigmine patch (e.g., allergic dermatitis requiring discontinuation).
Drug Interactions
Beta-blockers
Increased risk of bradycardia and syncope when co-administered.
Anticholinergic drugs
May antagonize the pharmacodynamic effects of rivastigmine, leading to reduced efficacy.
Other cholinesterase inhibitors
Concurrent use is not recommended due to increased risk of adverse effects without additional benefit.
Succinylcholine-type muscle relaxants
Rivastigmine, as a cholinesterase inhibitor, may prolong the muscle relaxant effects of succinylcholine during anesthesia.
Storage
Store below 30°C in a dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe nausea, vomiting, diarrhea, abdominal pain, bradycardia, hypotension, sweating, salivation, lacrimation, miosis, and severe muscle weakness. In severe cases, cholinergic crisis with convulsions and respiratory depression may occur. Treatment involves discontinuing rivastigmine and administering atropine sulfate.
Pregnancy & Lactation
Pregnancy Category C. Rivastigmine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether rivastigmine is excreted in human milk; therefore, breastfeeding is not recommended during treatment.
Side Effects
Contraindications
- Hypersensitivity to rivastigmine, other carbamate derivatives, or any excipients in the formulation.
- History of severe adverse skin reactions with rivastigmine patch (e.g., allergic dermatitis requiring discontinuation).
Drug Interactions
Beta-blockers
Increased risk of bradycardia and syncope when co-administered.
Anticholinergic drugs
May antagonize the pharmacodynamic effects of rivastigmine, leading to reduced efficacy.
Other cholinesterase inhibitors
Concurrent use is not recommended due to increased risk of adverse effects without additional benefit.
Succinylcholine-type muscle relaxants
Rivastigmine, as a cholinesterase inhibitor, may prolong the muscle relaxant effects of succinylcholine during anesthesia.
Storage
Store below 30°C in a dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe nausea, vomiting, diarrhea, abdominal pain, bradycardia, hypotension, sweating, salivation, lacrimation, miosis, and severe muscle weakness. In severe cases, cholinergic crisis with convulsions and respiratory depression may occur. Treatment involves discontinuing rivastigmine and administering atropine sulfate.
Pregnancy & Lactation
Pregnancy Category C. Rivastigmine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether rivastigmine is excreted in human milk; therefore, breastfeeding is not recommended during treatment.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date.
Availability
Available in pharmacies and hospitals
Approval Status
Approved by major regulatory bodies (e.g., FDA, DGDA)
Patent Status
Generic versions available, patent expired for active ingredient
Clinical Trials
Numerous clinical trials have established the efficacy and safety of rivastigmine in mild to moderate Alzheimer's and Parkinson's disease dementia. Ongoing research explores its role in other neurodegenerative conditions.
Lab Monitoring
- No specific routine laboratory monitoring is required for rivastigmine. However, in patients with severe renal or hepatic impairment, liver and kidney function tests may be periodically monitored.
- Monitor for significant weight loss.
Doctor Notes
- Emphasize slow dose titration to minimize cholinergic side effects, especially gastrointestinal ones.
- Monitor patients for significant weight loss or exacerbation of cardiac conditions.
- Advise patients and caregivers about the importance of consistent dosing and what to do for missed doses.
Patient Guidelines
- Take Rivadem exactly as prescribed by your doctor. Do not change the dose or stop the medication without consulting your doctor.
- Always take the capsule with food, preferably with morning and evening meals, to minimize stomach upset.
- If you experience any unusual or severe side effects, report them to your doctor immediately.
- Ensure adequate hydration to prevent dehydration, especially if experiencing vomiting or diarrhea.
Missed Dose Advice
If a dose is missed, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Rivadem may cause dizziness, drowsiness, or confusion, which can impair your ability to drive or operate machinery. Exercise caution and avoid these activities until you know how the medication affects you.
Lifestyle Advice
- Engage in regular cognitive activities and mental exercises to help maintain brain function.
- Maintain a balanced diet and healthy lifestyle.
- Regular physical activity may also be beneficial.
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