Rivastigmine, Transdermal

________________________________________________________________________

KEY POINTS

• This medicine is used on the skin to treat certain kinds of dementia. Use it exactly as directed.
• This medicine may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

________________________________________________________________________

What are other names for this medicine?

Type of medicine: acetylcholinesterase inhibitor

Generic and brand names: rivastigmine, transdermal; Exelon Patch

What is this medicine used for?

This medicine is put on the skin to treat symptoms of Alzheimer's-type dementia. It may also be used to treat dementia related to Parkinson's disease.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• Asthma or other breathing problems
• Heart disease or an irregular heartbeat, or a heart attack
• Liver problems
• Seizures
• Trouble urinating
• Ulcers
• Uncontrolled muscle movements

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

Check the label on the medicine for directions about your specific dose. Use this medicine exactly as your healthcare provider prescribes. Your provider may adjust the dosage to find the one that is best. Do not use more or less or use it longer than prescribed. Do not stop using this medicine without your healthcare provider's approval. Changing your dosage may cause a serious decline in your ability to think and control your behavior.

Check with your healthcare provider before using this medicine in children under age 18.

Wash your hands with soap and water before and after applying the patch. Apply the patch right after removing it from the sealed pouch. Place the sticky side of the patch on a clean, dry area of skin on the upper body where there is little or no hair. Examples are the upper or lower back, upper arm, or chest. Avoid injured, irritated, or scarred skin. Make sure the skin is free from powder, oil, moisturizer, or lotion. Avoid places where the patch can be rubbed off by tight clothing.

Make sure all the edges of the patch are firmly attached. Keep the patch on for 24 hours, then take it off and replace it with a new patch. When changing the patch, put the new patch on a different spot (for example on the right side of the body one day, then on the left side the next day). Do not apply a new patch to that same spot for at least 14 days.

If a patch falls off, apply a new patch for the rest of the day and then replace it the next day at the same time as usual.

You may bathe, swim, or shower while wearing the patch, However, do not use a heating pad, electric blanket, heat lamp, hot tub, or other direct heat where you apply the patch. These may increase the amount of medicine released from the patch and could result in an overdose.

To dispose of a used patch, fold it so that it sticks to itself with the medicine inside. Then dispose of it safely away from children and pets.

What if I miss a dose?

If you miss a dose of this medicine, apply it as soon as possible. If it is almost time to put on your next patch, wait until then to apply the patch and skip the one you missed. Do not apply extra patches to make up for the missed dose. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider. You may need to start the medicine again at a lower dose.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: severe nausea, vomiting, diarrhea, drooling, sweating, blurred vision, lightheadedness, slow heartbeat, shallow breathing, muscle weakness, fainting, seizures, drowsiness, tremor, confusion, hallucinations.

What should I watch out for?

This medicine may cause skin irritation where the patch is applied. Contact your healthcare provider if this irritation becomes severe, spreads beyond the patch size, or does not get better within 48 hours after removing the patch.

This medicine may cause urinary problems. If you have trouble urinating, contact your healthcare provider right away.

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help.

Smoking tobacco may lower the blood levels of this medicine. If you smoke, your healthcare provider may need to change the dosage of your medicine.

People who have Alzheimer's disease should not be allowed to drive, operate machinery, or perform other hazardous tasks. This medicine may cause dizziness and confusion, which can add to the problems caused by the disease itself.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are using this medicine. The patch may need to be removed before certain tests or procedures such as MRIs.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Severe nausea, vomiting, stomach pain, weight loss, wheezing, hallucinations (seeing or hearing things that are not there), worsening of tremors, seizures, blood in urine, black or tarry bowel movements, trouble urinating.

Other: Dizziness, diarrhea, nausea, loss of appetite, headache, tiredness, weakness, confusion, depression, anxiety, trouble sleeping, constipation, gas, skin irritation.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Alcohol
• Anticholinergic medicines such as amantadine (Symmetrel), belladonna, benztropine (Cogentin), dicyclomine (Bentyl), glycopyrrolate (Cuvposa, Robinul), hyoscyamine (HyoMax, Levbid, Levsin), methscopolamine (Pamine), propantheline, rimantadine (Flumadine), and trihexyphenidyl
• Antihistamines such as chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril), and meclizine (Dramamine)
• Beta blockers (taken by mouth) such as acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carteolol, carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), sotalol (Betapace, Sorine), and timolol
• Bladder control medicines such as darifenacin (Enablex), mirabegron (Myrbetriq), oxybutynin (Ditropan XL, Oxytrol), solifenacin (VESIcare), tolterodine (Detrol), and trospium
• Ceritinib (Zykadia)
• Medicines to treat breathing or lung problems such as ipratropium (Atrovent) and tiotropium (Spiriva)
• Metoclopramide (Metozolv, Reglan)
• Muscle relaxants such as cyclobenzaprine (Amrix) and orphenadrine (Norflex)
• Myasthenia gravis medicines such as neostigmine (Prostigmin) and pyridostigmine (Mestinon, Regonol)
• Nicotine (smoking) and nicotine replacement products such as Habitrol, NicoDerm, Nicorette, Nicotrol
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as diclofenac (Cambia, Voltaren, Zipsor), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, nabumetone (Relafen), naproxen (Aleve, Anaprox, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• Other Alzheimer's disease medicines such as donepezil (Aricept) and galantamine (Razadyne)
• Other forms of rivastigmine (Exelon) such as the capsules
• Propranolol (Hemangeol, Inderal, InnoPran)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

---

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.