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Precautions and Warnings With the Rivastigmine Patch

There are many precautions and warnings with the rivastigmine patch to be aware of, including possible side effects and information on who should not use this drug. For example, the rivastigmine patch may worsen some Parkinson's disease symptoms, cause seizures, and affect the heart. Precautions and warnings with the rivastigmine patch also extend to people are allergic to any components used to make the product.

The Rivastigmine Patch: What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to using the rivastigmine patch (Exelon® Patch) if you have:
  • Epilepsy or seizures
  • A low body weight (less than 110 pounds)
  • An upcoming surgery
  • Heart problems
  • Stomach or intestinal ulcers (or a history of such problems)
  • Bladder problems
  • Asthma
  • Any allergies, including allergies to food, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
Make sure to tell your healthcare provider about all other medicines you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Specific Precautions and Warnings With the Rivastigmine Patch

Warnings and precautions to be aware of prior to using the rivastigmine patch include the following:
  • The patch may interfere with your ability to drive or operate heavy machinery. Make sure you know how the medication affects you before performing such activities.
  • Even though the rivastigmine patch is approved to treat Parkinson's dementia, it can make some Parkinson's symptoms, such as tremors, worse. You and your healthcare provider may need to make a decision about whether the cognitive benefits of the patch are worth a worsening of the physical Parkinson's disease symptoms.
  • The patch can cause severe gastrointestinal reactions, such as severe nausea, vomiting, and diarrhea, especially at high doses. To help avoid such problems, the rivastigmine patch should always be started at the lowest dose and increased slowly. If you stop using the patch for an extended period, your healthcare provider should recommend that you restart back at the lowest dose. Let your healthcare provider know if you develop severe gastrointestinal side effects at any time.
  • Rivastigmine patches can cause allergic reactions, which are different and more severe than the normal mild skin reactions that are common with the patch. An allergic reaction (rather than just an irritation reaction) should be suspected if the reaction spreads beyond the patch size, if it is severe (it involves intense redness, swelling, or bumps), and if symptoms do not improve significantly within 48 hours after patch removal. If you are allergic to the patches, your healthcare provider should switch you to another medication (perhaps the oral form of rivastigmine).
  • The medication can cause significant weight loss, probably due to the other side effects of the rivastigmine patch, such as nausea, vomiting, diarrhea, and loss of appetite. Be sure to let your healthcare provider know if you lose a significant amount of weight while using the patch.
  • If you weigh less than 110 pounds, you may be at a higher risk for side effects. Your healthcare provider may need to monitor you more closely while you are using the patch.
  • The rivastigmine patch may increase the production of stomach acid, perhaps increasing the risk of stomach or intestinal ulcers. If you have an ulcer (or a history of ulcers), your healthcare provider should monitor you closely to make sure the patch is not making these problems worse.
  • The patch may have effects on the heart, possibly causing a dangerously slow heart rate. This is probably more common in people with heart conditions, but can occur in people without any heart problems.
  • The rivastigmine patch can impair the ability of the bladder to empty, perhaps causing difficulty urinating. Let your healthcare provider know if you develop any bladder problems while using the patch.
  • The rivastigmine patch could cause seizures or make seizures worse. However, Alzheimer's disease itself may also cause seizures.
  • The patch may cause a worsening of asthma symptoms. Check with your healthcare provider before using the rivastigmine patch if you have asthma.
  • If you have a surgery planned, make sure to let your surgeon and anesthesiologist know you are using the rivastigmine patch, as it can interact with some medications used during anesthesia.
  • The rivastigmine patch can potentially interact with several medications (see Drug Interactions With the Rivastigmine Patch).
  • The rivastigmine patch is considered a pregnancy Category B medication. This means that it is probably safe for use during pregnancy, although the full risks are not known (see Exelon and Pregnancy).
  • It is not known whether the medication in the rivastigmine patch passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to using it (see Exelon and Breastfeeding).
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