Exelon

Acetylcholine is a natural compound known as a neurotransmitter. Neurotransmitters are stored in nerve cells in the brain and nervous system, and are involved in transmitting messages between the nerve cells. They are necessary for the normal functioning of the brain and nervous system. Acetylcholine in the brain is continually being released by nerve cells, and then broken down by another natural chemical called acetylcholinesterase.

One of the features of both Alzheimer's disease and Parkinson's disease appears to be a lower than normal level of acetylcholine in the brain. This is due in part to degeneration of brain cells, in particular those that normally release acetylcholine.

Rivastigmine increases the level of acetylcholine in the brain. It does this by preventing the action of acetylcholinesterase, the compound which normally breaks it down. This slows the breakdown of acetylcholine that is released from remaining undamaged nerve cells in the brain.

The result of this is increased activity of acetylcholine in the brain. This improves the cognitive processes of thinking, learning and memory, and improves the symptoms of dementia and daily functioning in Alzheimer's disease.

Rivastigmine is used to treat mild to moderately severe dementia in people with Alzheimer's disease or Parkinson's disease. However, it only slows the worsening of the dementia, rather than being a cure. If the medicine has not slowed the worsening of symptoms after three months of treatment at the maintenance dose, it should be stopped. For patients who continue treatment, the benefit of the medicine should be reassessed on a regular basis and stopped when it is considered that the medicine is no longer providing a beneficial effect.

What is it used for?

- Mild to moderately severe Alzheimer's dementia
- Mild to moderately severe dementia in people with Parkinson's disease

Warning!

- A doctor will only prescribe this medicine if the patient has a caregiver available who will regularly make sure that the patient is taking the medicine.
- When starting treatment with this medicine the dose will be increased gradually to reduce the chances of side effects. Follow the instructions given by the doctor.
- If unwanted effects are experienced during treatment with the medicine, for example nausea, vomiting, abdominal pain, loss of appetite, weight loss, hallucinations, or worsening of tremor or other movement problems in people with Parkinson's disease, particularly if these occur after any dose increases, you should tell your doctor. These side effects usually improve if the dose of the medicine is decreased.
- If treatment is stopped for more than a few days it should be restarted at the lowest dose, as directed by your doctor.
- This medicine may cause dizziness and sleepiness. Patients will need to take care when performing potentially hazardous activites.
- People with Alzheimer's disease lose weight. This medicine may also cause weight loss. For this reason body weight should be regularly monitored in people taking this medicine.

Use with caution in

- Decreased kidney function
- Mild to moderately decreased liver function
- A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome)
- Defects of the heart's electrical message pathways, causing irregular heartbeats (heart conduction defects, eg heart block)
- History of, or current active peptic ulcer
- History of asthma
- History of chronic obstructive pulmonary disease
- History of difficulty passing urine (urinary obstruction)
- History of fits (seizures), eg epilepsy
- Parkinson's disease

Not to be used in

- Severely decreased liver function
- Breastfeeding.
- This medicine is not recommended for use in children.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- The safety of this medicine for use during pregnancy has not been established. It should not be used during pregnancy unless considered essential by your doctor. Seek medical advice from your doctor.
- It is not known whether this medicine passes into breast milk. Mothers who need to take this medicine should not breastfeed. Seek medical advice from your doctor.

Label warnings

- This medication should be taken with or after food.
- Exelon capsules should be swallowed whole, not chewed.

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