Rivadem
Generic Name
Rivastigmine
Manufacturer
Acme Laboratories Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| rivadem 45 mg capsule | ৳ 60.00 | ৳ 600.00 |
Description
Overview of the medicine
Rivastigmine is a cholinesterase inhibitor used to treat mild to moderate dementia of the Alzheimer's type and mild to moderate dementia associated with Parkinson's disease. It works by increasing the amount of certain natural substances in the brain.
Uses & Indications
Dosage
Adults
Initial dose is 1.5 mg twice daily. If tolerated, the dose may be increased in increments of 1.5 mg twice daily, at intervals of at least two weeks, up to a maximum recommended dose of 6 mg twice daily (12 mg/day). Rivadem 4.5 mg capsule is typically used in the maintenance phase after titration.
Elderly
No specific dose adjustment is required, but titration should be done carefully due to increased susceptibility to side effects.
Renal_impairment
No dose adjustment is needed for mild to moderate renal impairment. For severe renal impairment, use with caution and slower titration.
How to Take
Take orally twice daily, in the morning and evening, with meals to reduce gastrointestinal side effects.
Mechanism of Action
Rivastigmine reversibly inhibits both acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), thereby increasing the concentration of acetylcholine (ACh) in the synaptic cleft. This enhancement of cholinergic neurotransmission helps improve cognitive function in patients with dementia.
Pharmacokinetics
Onset
Cognitive benefits may be observed after several weeks of consistent dosing, with full effects typically seen after dose titration.
Excretion
Mainly through renal excretion (urine) as inactive metabolites. Less than 1% is excreted unchanged.
Half life
Approximately 1-2 hours for the parent drug.
Absorption
Rapidly and completely absorbed from the gastrointestinal tract, with peak plasma concentrations typically within 1 hour. Absolute bioavailability is approximately 36% due to first-pass metabolism.
Metabolism
Primarily metabolized by cholinesterase-mediated hydrolysis (non-CYP450 pathway).
Side Effects
Contraindications
- Hypersensitivity to rivastigmine, other carbamate derivatives, or any component of the formulation.
- History of severe adverse skin reactions with rivastigmine transdermal patch.
Drug Interactions
Anticholinergic medications
May interfere with the activity of anticholinergic drugs. Avoid concomitant use.
Succinylcholine-type muscle relaxants
May prolong the muscle-relaxing effects during anesthesia.
Beta-blockers (e.g., those causing bradycardia)
Potential for additive bradycardia (slow heart rate). Monitor heart rate.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe nausea, vomiting, diarrhea, abdominal pain, salivation, sweating, bradycardia, hypotension, collapse, and convulsions. Management involves general supportive measures. Atropine may be used for significant cholinergic crisis.
Pregnancy & Lactation
Pregnancy Category B. Use during pregnancy only if clearly needed. Rivastigmine is excreted in human breast milk; therefore, caution should be exercised when administered to a nursing woman.
Side Effects
Contraindications
- Hypersensitivity to rivastigmine, other carbamate derivatives, or any component of the formulation.
- History of severe adverse skin reactions with rivastigmine transdermal patch.
Drug Interactions
Anticholinergic medications
May interfere with the activity of anticholinergic drugs. Avoid concomitant use.
Succinylcholine-type muscle relaxants
May prolong the muscle-relaxing effects during anesthesia.
Beta-blockers (e.g., those causing bradycardia)
Potential for additive bradycardia (slow heart rate). Monitor heart rate.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe nausea, vomiting, diarrhea, abdominal pain, salivation, sweating, bradycardia, hypotension, collapse, and convulsions. Management involves general supportive measures. Atropine may be used for significant cholinergic crisis.
Pregnancy & Lactation
Pregnancy Category B. Use during pregnancy only if clearly needed. Rivastigmine is excreted in human breast milk; therefore, caution should be exercised when administered to a nursing woman.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months 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
Clinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of rivastigmine in improving cognitive function and global clinical status in patients with mild to moderate Alzheimer's disease and Parkinson's disease dementia.
Lab Monitoring
- Baseline weight and periodic monitoring of weight.
- Liver function tests if clinically indicated.
- ECG for patients with pre-existing cardiac conduction abnormalities.
Doctor Notes
- Advise slow titration to mitigate gastrointestinal side effects, especially in elderly or frail patients.
- Monitor patients for signs of bradycardia or worsening of pre-existing cardiac conditions, particularly during dose increases.
- Educate caregivers on proper administration and what symptoms to report.
Patient Guidelines
- Take Rivadem-45 mg capsule exactly as prescribed by your doctor; do not alter the dose without consulting them.
- Always take the capsule with food to minimize stomach upset.
- Report any severe gastrointestinal symptoms, worsening of dementia, or unusual skin reactions to your doctor immediately.
Missed Dose Advice
If a dose is missed, take the next scheduled dose at the regular time. Do not double the dose to compensate for a missed one. If several doses are missed, consult a doctor regarding re-titration.
Driving Precautions
Rivastigmine may cause dizziness, somnolence, or syncope. Patients should be cautioned about driving or operating machinery until they are certain that the medicine does not adversely affect their ability to perform such tasks.
Lifestyle Advice
- Maintain a healthy diet and ensure adequate hydration.
- Engage in cognitive and physical activities as tolerated, which can help manage dementia symptoms.
- Ensure a safe home environment to prevent falls and injuries.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.
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