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Exelon Fact Sheet

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Medication Name (brand): 
Exelon
Medication Name (clinical): 
rivastigmine
Manufacturer: 

Novartis; patent expires 2012.

Indications: 
  • Mild to moderate Alzheimer’s dementia.

  • Mild to moderate dementia associated with Parkinson’s disease.
  • Off-label use for severe dementia and mild cognitive impairment.

Mechanism: 

Acetylcholinesterase inhibitor. Enhances brain cholinergic function.

Dosing: 
  • Supplied as:

  • 1.5 mg yellow, 3 mg orange, 4.5 mg red, and 6 mg orange and red capsules.
  • Oral solution available in 2 mg/mL strength.
  • Start at 1.5 mg BID, wait at least two weeks before increasing to 3 mg BID. The maximum recommended dose is 6 mg BID.
  • You may need to decrease the dose in both hepatic and renal impairment.

Side Effects: 
  • Most common: nausea (47% of patients in clinical trials), vomiting (31%), dizziness (21%), diarrhea (19%), insomnia, fatigue.

  • Occasionally: agitation, nightmares.
  • May aggravate stomach ulcers (potential class effect of all cholinesterase inhibitors).
  • Pregnancy risk category B.

Drug-drug Interactions: 

None reported.

Pharmokinetics: 
  • Metabolized by the liver, but the P450 system is not involved.

  • Half-life 1.5 hours.

Pearls: 
  • High rate of nausea and vomiting; dose cautiously to avoid this.

  • Exelon patch likely to be approved soon.

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