Rivastigmine transdermal (skin patch) is used to treat mild to moderate dementia caused by Alzheimer's or Parkinson's disease.

Rivastigmine improves the function of nerve cells in the brain. It works by preventing the breakdown of a chemical that is important for the processes of memory, thinking, and reasoning. People with dementia usually have lower levels of this chemical.

Rivastigmine transdermal may also be used for purposes not listed in this medication guide.

You should not use rivastigmine transdermal if you have ever had severe redness, itching, or skin irritation where a rivastigmine transdermal skin patch was worn.

Do not take rivastigmine capsules or oral liquid at the same time you are wearing the skin patch.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Do not take by mouth. The transdermal patch is for use only on the skin.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

Apply the patch to clean, dry, and hairless skin. Do not use on broken or irritated skin. Press the patch firmly into place for about 30 seconds to make sure it sticks. You may leave the patch on while bathing, showering, or swimming.

Remove the skin patch after 24 hours and replace it with a new one. Always remove an old patch before putting on a new one.

Do not wear more than one rivastigmine patch at a time. Using extra skin patches will not make the medication more effective.

If a patch falls off, apply a new patch and wear it for the rest of the day. Change the patch at your usual time the next day.

Choose a different place on your body to wear the patch each time you put on a new one. Do not use the same skin area twice within 14 days.

Always wash your hands after removing the patch.

After removing a patch, fold it in half so it sticks together and throw it away in a place where children or pets cannot get to it. A used skin patch could be fatal to a child or pet who accidentally chews on the patch. Seek emergency medical attention if this happens.

It may take up to 4 weeks before your symptoms improve. For best results, keep using the patches as directed.

If you need surgery, tell your surgeon you currently use rivastigmine transdermal.

If you stop using rivastigmine for any reason, do not restart the medicine without talking to your doctor first. You may need to start with a lower dose.

Store at room temperature away from moisture and heat. Keep each patch in its foil pouch until you are ready to use it.

Usual Adult Dose for Alzheimer's Disease:

MILD TO MODERATE ALZHEIMER'S DISEASE:
ORAL:
-Initial dose: 1.5 mg orally twice a day
-Maintenance dose: After a minimum of 2 weeks of treatment, if the initial dosage is well tolerated, it can be increased to 3 mg twice a day; subsequent increases to 4.5 mg and 6 mg twice a day should be attempted only after a minimum of 2 weeks at the previous dosage

TRANSDERMAL PATCH:
-Initial Dose: 4.6 mg/24 hour patch applied to the skin once daily
-Maintenance Dose: After a minimum of 4 weeks of treatment at the initial dose, and if well tolerated, the dose can be increased to 9.5 mg/24 hours for as long as this dose is beneficial; the dose can then be increased to 13.3 mg/24 hours
-Maximum Dose: 13.3 mg/24 hour patch applied to skin daily; higher doses confer no appreciable additional benefit, and are associated with significant increase in the incidence of adverse events

SEVERE ALZHEIMER'S DISEASE:
TRANSDERMAL PATCH:
-Recommended dose: 13.3 mg/24 hours transdermal patch applied to skin once daily; replace with a new patch every 24 hours

Use: For the treatment of mild, moderate, or severe dementia of the Alzheimer's type (AD)

Usual Adult Dose for Parkinson's Disease:

MILD TO MODERATE PARKINSON'S DISEASE DEMENTIA:
ORAL:
Initial dose: 1.5 mg orally twice a day with morning and evening meals
Maintenance dose: Subsequently, the dose can be increased to 3 mg orally twice a day and further to 4.5 mg twice a day and 6 mg twice a day (based on tolerability) with a minimum of 4 weeks at each dose

TRANSDERMAL PATCH:
Initial dose: 4.6 mg/24 hours applied to the skin once a day
Maintenance dose: After a minimum of four weeks of treatment and if well tolerated, the dose of the patch can be increased to 9.5 mg/24 hours for as long as this dose is beneficial. The dose can then be increased to 13.3 mg/24 hours.
Maximum dose: 13.3 mg/24 hours. Higher doses confer no appreciable additional benefit, and are associated with significant increase in the incidence of adverse events.

Use: For the treatment of mild to moderate dementia associated with Parkinson's disease

You should not use this medicine if you are allergic to rivastigmine or similar medicines, such as felbamate, meprobamate, or carisoprodol.

You should not use this medicine if you have ever had severe redness, itching, or skin irritation where a rivastigmine transdermal skin patch was worn.

Tell your doctor if you have ever had:

• an ulcer or stomach bleeding;

• a seizure;

• heart problems;

• liver or kidney disease;

• urination problems; or

• asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorder.

Tell your doctor if you are pregnant or plan to become pregnant.

It may not be safe to breast-feed while using this medicine. Ask your doctor about any risk.

If you forget to change the skin patch, remove it and apply a new one as soon as you remember. Do not wear extra patches to make up a missed dose.

Call your doctor for instructions if you miss more than 3 doses of rivastigmine.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Avoid placing the patch where it will be rubbed by tight clothing.

Avoid touching your eyes after handling a skin patch.

Do not use lotion, oil, or powder on the skin where you plan to apply a skin patch. The patch may not stick to the skin.

Avoid driving or hazardous activity until you know how rivastigmine transdermal will affect you. Your reactions could be impaired.

Avoid applying heat to the skin where the patch is worn, because it may increase the amount of medicine your body absorbs. Heat sources include hot tubs, heating pads, heat lamps, saunas, heated water beds, and direct sunlight.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Rivastigmine transdermal may cause serious side effects. Call your doctor at once if you have:

• itching, redness, swelling, peeling, blistering, or skin sores where the patch is worn;

• severe or ongoing vomiting or diarrhea with weight loss;

• bloody or tarry stools, cough with bloody mucus or vomit that looks like coffee grounds;

• a light-headed feeling, like you might pass out;

• tremors (uncontrolled shaking), restless muscle movements in your eyes, tongue, jaw, or neck;

• seizures (convulsions);

• painful or difficult urination;

• severe skin redness, itching, or irritation; or

• dehydration symptoms--feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin.

Common side effects of rivastigmine transdermal may include:

• headache, dizziness;

• depression, anxiety;

• tiredness, muscle weakness;

• stomach pain; or

• trouble sleeping.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Tell your doctor about all your other medicines, especially:

• medicine to treat depression, anxiety, mood disorders, or mental illness;

• cold or allergy medicine (Benadryl and others);

• medicine to treat Parkinson's disease;

• medicine to treat stomach problems, motion sickness, or irritable bowel syndrome;

• medicine to treat overactive bladder;

• bronchodilator asthma medication; or

• an NSAID (nonsteroidal anti-inflammatory drug such as aspirin, ibuprofen, naproxen, Advil, Motrin, Aleve, and others.

This list is not complete and many other drugs may affect rivastigmine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.