Exelon (Rivastigmine) - Transdermal

What Is Exelon?

Exelon is a prescription transdermal patch used to treat dementia in adults with Alzheimer's or Parkinson's disease. Exelon belongs to a group of drugs called acetylcholinesterase inhibitors.

Exelon works by blocking the breakdown of acetylcholine—an important neurotransmitter (or chemical messenger) in the brain. Acetylcholine activity is reduced in people with certain forms of dementia, so increasing levels can help improve symptoms.

Drug Facts

Generic Name: Rivastigmine

Brand Name(s): Exelon

Drug Availability: Prescription

Therapeutic Classification: Acetylcholinesterase inhibitor

Available Generically: Yes

Controlled Substance: No

Administration Route: Transdermal

Active Ingredient: Rivastigmine

Dosage Form(s): Transdermal patch

What Is Exelon Used For?

Exelon is a prescription transdermal patch used to treat dementia caused by Alzheimer's or Parkinson's disease in adults. It may help improve memory, communication, reasoning, and the ability to complete daily tasks. While Exelon can improve symptoms in some people, it does not cure the disease.

Alzheimer's disease affects about 1 in 9 people age 65 and older in the United States and is the most common cause of dementia. Alzheimer's disease is a progressive brain disorder, which means it gets worse over time. Early symptoms may include trouble remembering recent conversations, names, or events, lack of interest, and depression. As the disease progresses, symptoms may include:

  • Trouble communicating
  • Confusion
  • Poor judgment
  • Trouble bathing, dressing, or going to the bathroom
  • Incontinence
  • Agitation and suspiciousness
  • Behavioral changes
  • Difficulty speaking, swallowing, and walking

Parkinson's disease (PD) is a movement disorder that affects 1% to 4% of adults over 60, although some people may develop PD at a younger age. People with Parkinson's disease often experience the following:

  • Shaking of the hands, arms, legs, jaw, and face
  • Stiffness in the arms, legs, and trunk
  • Slowed movement
  • Trouble with balance and coordination

As PD progresses, some people may develop cognitive problems, including dementia.

How to Take Exelon

One Exelon patch should be applied to your skin once daily. Follow these tips to ensure you apply Exelon correctly and safely:

  • Do not use it if the outer pouch seal is broken or the patch is cut or damaged.
  • Apply the Exelon patch to clean, dry, hairless, intact, and healthy skin.
  • Application to an area on the upper or lower back is best since it is less likely to be removed.
  • If the upper or lower back cannot be used, apply the patch to the upper arm or chest.
  • Avoid areas where tight clothing will rub against the patch.
  • Do not apply to red, irritated, or cut skin.
  • Avoid using lotions, creams, or powders on the application site. 
  • To apply, press down firmly for 30 seconds until the edges stick well.
  • Replace the Exelon patch every 24 hours. Remove the old patch before applying a new patch. Overdoses have occurred when more than one patch was accidentally worn.
  • If the patch falls off, apply a new patch immediately. Replace the new patch the following day at your regular application time.
  • Change the application site each day to avoid skin irritation. Do not use the same spot for at least 14 days.
  • Exelon patches may be worn while bathing or in hot weather.
  • Avoid prolonged exposure to heat sources, such as excessive sunlight or saunas.
  • Fold used patches in half, with the adhesive surface pressed together. Place the folded patch in the original, saved pouch, and discard it in the trash. The patch still contains medication even after 24 hours of use, so keep the trash away from children and pets.
  • Wash hands well after removing the patch. If the patch or residue on your hands comes into contact with your eyes, rinse your eyes well with water. Seek medical care if your eyes remain red or irritated.

Storage

Store Exelon patches in their sealed pouch at room temperature (68 to 72 degrees Fahrenheit (F)). After use, fold the patch in half with the adhesive side pressed together. Place the used, folded patch in the saved pouch and discard it in the trash.

Keep Exelon patches and trash containing discarded patches away from children and pets.

How Long Does Exelon Take to Work?

The time it takes Exelon to work may be different for everyone. Your healthcare provider will likely start you at a low dose. They may increase your dose after four weeks based on your symptoms. Check with your healthcare provider or pharmacist if you have any questions.

What Are the Side Effects of Exelon?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

You may experience side effects while taking Exelon. Be sure to inform your healthcare provider if you develop any side effects that bother you or don't go away.

Common side effects include:

Severe Side Effects

Exelon may sometimes cause severe and even life-threatening reactions. Contact your healthcare provider immediately if you develop any signs of a severe reaction. Call 911 if your symptoms feel life-threatening.

Serious side effects and their symptoms include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Loss of appetite
  • Weight loss
  • Black or tarry stools
  • Red blood in stool
  • Vomit that looks like coffee grounds
  • Seizures
  • Tremors (shaking)

Stomach or intestinal problems can lead to dehydration and other serious complications. Tell your healthcare provider if you develop any of the symptoms mentioned above.

Skin reactions, including allergic contact dermatitis, may also occur. Let your healthcare provider know if you develop:

  • A reaction that spreads beyond where the patch was placed
  • Skin symptoms that are intense and do not improve within 48 hours of removing the patch
  • Itching, redness, swelling, warmth, or tender skin
  • Skin peeling or blistering with or without oozing or crusting

Report Side Effects

Exelon may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Exelon Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (capsules or solution):
    • For treatment of Alzheimer's disease:
      • Adults—At first, 1.5 milligrams (mg) two times a day. Your doctor may gradually increase your dose as needed and tolerated. However, the dose is usually not more than 6 mg two times a day.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of Parkinson's disease:
      • Adults—At first, 1.5 milligrams (mg) two times a day. Your doctor may gradually increase your dose as needed and tolerated. However, the dose is usually not more than 6 mg two times a day.
      • Children—Use and dose must be determined by your doctor.

Modifications

The following modifications (changes) should be kept in mind when using Exelon:

Severe allergic reaction: Avoid using Exelon if you have a known allergy to it or have developed a skin reaction called allergic contact dermatitis.

Pregnancy: In animal studies, Exelon was not found to cause harm to the fetus. However, there is not enough information about the safety and effectiveness of Exelon in pregnant people and their unborn fetuses. Let your healthcare provider know if you're pregnant or if you plan to become pregnant, and discuss the benefits and risks of taking Exelon during your pregnancy.

Breastfeeding: In animal studies, Exelon was present in rat breast milk. There is insufficient information regarding the safety of Exelon in human breast milk and nursing babies. Talk with your healthcare provider if you plan to breastfeed, and discuss the benefits and risks of taking Exelon while nursing and different ways to feed your baby.

Adults over 65: During clinical studies, no overall differences in the safety or effectiveness of using Exelon were observed in adults over 65 compared to younger adults.

Children: The safety and effectiveness of using Exelon in children have not been studied.

Liver problems: Individuals with liver problems may not be able to clear medication from their bodies as easily. This means the medicine stays in the body longer and can have increased side effects. For this reason, your healthcare provider may prescribe a lower dose of Exelon if you have liver impairment.

Low body weight: People with low body weight (less than 110 pounds) may be more susceptible to Exelon's side effects. Your healthcare provider will monitor you closely for reactions and may keep you on a low dose of Exelon.

Missed Dose

If you accidentally forgot to apply your Exelon patch, apply it as soon as you remember. Replace the new patch the following day at your usual application time. Call your healthcare provider before restarting if you've missed three or more days of treatment. They will likely continue you on a reduced dose to prevent side effects, including severe vomiting.

Try to help yourself remember to keep your appointments and take your medication routinely. If you miss too many doses, Exelon might be less effective at treating your symptoms.

Overdose: What Happens If I Take Too Much Exelon?

Wearing more than one Exelon patch at a time can result in an overdose. Symptoms can be severe and, in rare cases, deadly. You must remove the old patch before applying a new one.

The symptoms of an Exelon overdose include:

  • Severe nausea
  • Vomiting
  • Increased salivation (saliva production)
  • Sweating
  • Slowed heartbeat
  • Low blood pressure
  • Slowed breathing
  • Seizures
  • Muscle weakness that can prevent breathing

If you think you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

What Happens If I Overdose on Exelon?

If you think you or someone else may have overdosed on Exelon, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Exelon, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to check for unwanted effects.

Rivastigmine may cause nausea, vomiting, diarrhea, stomach pain, loss of appetite, or weight loss. Tell your doctor if any of these problems are severe, because they could cause other health problems such as dehydration.

If you develop a skin rash, hives, or any allergic reaction to this medicine, stop taking the medicine and check with your doctor as soon as possible.

Before you have any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine. Taking rivastigmine together with medicines that are sometimes used during surgery or dental or emergency treatments may increase the effects of these medicines.

Rivastigmine may cause some people to become dizzy, clumsy, or unsteady. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

Do not stop taking this medicine or decrease your dose without first checking with your doctor. Stopping this medicine suddenly or decreasing the dose by a large amount may cause mental or behavior changes.

If you think you or someone else may have taken an overdose of rivastigmine, get emergency help at once. Taking an overdose of rivastigmine may lead to convulsions (seizures) or shock. Some signs of shock are large pupils, irregular breathing, and fast weak pulse. Other signs of an overdose are severe nausea and vomiting, increasing muscle weakness, greatly increased sweating, and greatly increased watering of the mouth.

Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines, such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.

What Are Reasons I Shouldn’t Take Exelon?

Do not take Exelon if you:

  • Are allergic to rivastigmine or any other ingredient in Exelon
  • Are allergic to chemically similar drugs, such as neostigmine, physostigmine, or pyridostigmine
  • Have had a skin reaction called allergic contact dermatitis from Exelon in the past

Be sure to let your healthcare provider know about your allergies and medical conditions so they can ensure Exelon is the best treatment for you.

What Other Medications Interact With Exelon?

Use caution when taking Exelon with the following medications:

Many other drugs may interact with Exelon. Be sure to let your healthcare provider and pharmacist know about medicines you take, including over-the-counter (OTC), nonprescription products, vitamins, and herbal supplements.

What Medications Are Similar?

Exelon belongs to a group of drugs called acetylcholinesterase inhibitors. Other acetylcholinesterase inhibitors include:

These medications differ based on their formulations (i.e., tablets, solutions, orally disintegrating tablets, daily or weekly transdermal patches), how often they need to be taken, and side effects. Exelon patches may be more tolerable for some people compared to oral medicines. You and your healthcare provider will work together to choose the best option.

Frequently Asked Questions

  • What is Exelon used for?

    Exelon is used to treat dementia caused by Alzheimer's or Parkinson's disease.

  • How does Exelon work?

    Exelon increases levels of a brain chemical called acetylcholine. Acetylcholine activity is reduced in people with dementia, so increasing levels can help improve symptoms.

  • What are the side effects of Exelon?

    Exelon's most common side effects include nausea, vomiting, and diarrhea.

How Can I Stay Healthy While Taking Exelon?

If you or a loved one are taking Exelon, the symptoms of dementia have likely begun to negatively affect your quality of life. You may have tried different approaches or treatments. While living with or caring for a loved one with dementia can be challenging, there are ways to help improve your quality of life. Refer below for some general tips to support your health:

  • Take dementia-related medications as recommended by your healthcare provider.
  • Establish a daily routine, but be flexible. Specific tasks may take longer than they used to.
  • Limit napping during the day. This can help prevent confusing days and nights.
  • Install safety measures around the house as needed, including protective covers on the stove knobs, locks on cabinets that contain anything dangerous, and childproof door handle covers.
  • Consider joining a dementia caregiver support group that can help provide advice, resources, and coping strategies.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Ferreira-Vieira TH, Guimaraes IM, Silva FR, et al. Alzheimer's disease: targeting the cholinergic systemCurr Neuropharmacol. 2016;14(1):101-115. doi:10.2174/1570159x13666150716165726

  3. Alzheimer's Association. 2022 alzheimer's disease facts and figures.

  4. Centers for Disease Control and Prevention. Genetics, coffee consumption, and parkinson's disease.

  5. MedlinePlus. Parkinson's disease.

  6. MedlinePlus. Rivastigmine transdermal patch.

  7. Mohammad D, Chan P, Bradley J, et al Acetylcholinesterase inhibitors for treating dementia symptoms - a safety evaluationExpert Opin Drug Saf. 2017;16(9):1009-1019. doi:10.1080/14740338.2017.1351540

By Christina Varvatsis, PharmD
Christina Varvatsis is a hospital pharmacist and freelance medical writer. She is passionate about helping individuals make informed healthcare choices by understanding the benefits and risks of their treatment options.