Exelon: Advanced Cognitive Support for Dementia Management
Exelon
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| Product dosage: 6mg | |||
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Synonyms | |||
Exelon (rivastigmine) is a prescription medication specifically formulated for the treatment of mild to moderate dementia associated with Alzheimer’s disease and Parkinson’s disease. As a reversible cholinesterase inhibitor, it functions by increasing the levels of acetylcholine, a crucial neurotransmitter involved in memory, thinking, and reasoning. This targeted mechanism of action helps to mitigate the cognitive decline characteristic of these neurodegenerative conditions, offering patients a potential pathway to sustained mental function and improved daily living. Clinical evidence supports its role in stabilizing cognitive performance and supporting functional abilities over time.
Features
- Active pharmaceutical ingredient: Rivastigmine
- Available formulations: Oral capsules, oral solution, and transdermal patches
- Dosage strengths: Capsules: 1.5 mg, 3 mg, 4.5 mg, 6 mg; Solution: 2 mg/mL; Patch: 4.6 mg/24 h, 9.5 mg/24 h, 13.3 mg/24 h
- Pharmacologic class: Cholinesterase inhibitor
- Prescription status: Available by prescription only
Benefits
- Slows Cognitive Decline: Works to slow the progression of memory loss, confusion, and problems with thinking and reasoning.
- Improves Functional Abilities: Can help patients maintain their ability to perform everyday activities, such as dressing or eating, for a longer period.
- Supports Behavioral Symptoms: May contribute to the reduction of certain behavioral symptoms like apathy, anxiety, and delusions.
- Offers Dosing Flexibility: Available in multiple formulations to suit individual patient needs, tolerability, and preferences, including a transdermal patch that can minimize gastrointestinal side effects.
- Evidence-Based Efficacy: Supported by extensive clinical trials demonstrating statistically significant benefits in cognitive and global function scales compared to placebo.
Common use
Exelon is indicated for the treatment of mild to moderate dementia of the Alzheimer’s type. It is also approved for the treatment of mild to moderate dementia associated with Parkinson’s disease. It is used as a symptomatic treatment to address the core cognitive and functional impairments caused by these conditions. It is not a cure for dementia but is a key component of a comprehensive management plan that often includes psychosocial interventions and caregiver support.
Dosage and direction
Initial Dose: Treatment must be initiated and supervised by a physician experienced in dementia diagnosis and management.
- Oral Capsules/Solution: The recommended starting dose is 1.5 mg twice daily. Based on tolerability, the dose may be increased to 3 mg twice daily, 4.5 mg twice daily, and finally to 6 mg twice daily after a minimum of two weeks at each dose level. The maximum recommended dose is 6 mg twice daily (12 mg per day).
- Transdermal Patch: Treatment is initiated with the 4.6 mg/24 h patch. After a minimum of four weeks, if well tolerated, the dose may be increased to the 9.5 mg/24 h patch, which is the effective maintenance dose. The 13.3 mg/24 h patch is available for patients with severe dementia who have been on the 9.5 mg/24 h patch for at least 4 weeks and require a higher dose.
- Administration: Capsules should be taken with food in the morning and evening. The oral solution can be taken directly from the syringe or mixed with a small glass of water, cold fruit juice, or soda; it should be taken with food. The transdermal patch should be applied to clean, dry, intact, and hairless skin on the upper or lower back, upper arm, or chest, avoiding areas that might be rubbed by tight clothing. The patch should be replaced with a new one every 24 hours, applied to a different skin site.
Precautions
- Gastrointestinal Effects: Exelon can cause significant nausea, vomiting, diarrhea, anorexia, and weight loss. These effects are more common during the dose-escalation phase and with the oral formulation. Dose escalation should be delayed if these side effects occur.
- Cardiac Conduction: Cholinesterase inhibitors may have vagotonic effects on heart rate (e.g., bradycardia). Patients with sick sinus syndrome, conduction abnormalities, or other supraventricular cardiac conduction conditions should be monitored closely.
- Peptic Ulcers/GI Bleeding: Use with caution in patients at increased risk of developing ulcers, including those with a history of ulcer disease or those taking NSAIDs concurrently.
- Genitourinary Effects: May cause bladder outflow obstruction.
- Seizures: Cholinesterase inhibitors are believed to have some potential to cause generalized seizures.
- Pulmonary Conditions: Use with caution in patients with a history of asthma or obstructive pulmonary disease.
- Weight Monitoring: Patient weight should be monitored regularly during therapy.
Contraindications
Exelon is contraindicated in patients with:
- A known hypersensitivity to rivastigmine, other carbamate derivatives, or any other components of the formulation.
- A history of application site reactions with the transdermal patch that were persistent and more severe than moderate redness.
Possible side effect
The most common side effects are related to its cholinergic activity and are often dose-dependent.
- Very Common (≥1/10): Nausea, vomiting, diarrhea, anorexia, dizziness, headache.
- Common (≥1/100 to <1/10): Abdominal pain, dyspepsia, fatigue, asthenia, malaise, tremor, agitation, confusion, anxiety, insomnia, depression, weight decreased.
- Uncommon (≥1/1,000 to <1/100): Dehydration, syncope, bradycardia, gastric ulcer, urinary tract infection.
- Transdermal Patch Specific: Application site reactions (erythema, pruritus, rash, irritation, edema).
Drug interaction
- Other Cholinesterase Inhibitors: Concurrent use with drugs of a similar pharmacological class (e.g., donepezil, galantamine) is not recommended due to additive cholinergic effects and increased risk of toxicity.
- Anticholinergic Medications: Drugs that inhibit the action of acetylcholine (e.g., oxybutynin, tolterodine, some antihistamines, tricyclic antidepressants) can antagonize the therapeutic effect of Exelon.
- Cholinergic Agonists: May have a synergistic effect with drugs like bethanechol, increasing the risk of side effects.
- Neuromuscular Blocking Agents: Cholinesterase inhibitors may exaggerate the neuromuscular blocking effect of succinylcholine-type agents.
- Beta-Blockers: The combination may potentiate the risk of bradycardia.
Missed dose
- If a dose of the oral formulation is missed, it should be skipped and the next dose taken at the usual time. Do not take a double dose to make up for the missed one.
- If a transdermal patch application is missed, a new patch should be applied as soon as it is remembered. The next patch should be applied at the regular time the following day. Only one patch should be worn at any given time.
Overdose
Symptoms: An overdose is likely to result in a severe cholinergic crisis characterized by intense nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, syncope, and convulsions. Increasing muscle weakness is a possibility and may result in death if respiratory muscles are involved. Management: Symptomatic treatment is essential. Tertiary anticholinergics such as atropine can be used as an antidote, with an initial intravenous dose of 0.03 mg/kg. All doses of Exelon should be withheld. General supportive measures should be instituted. Due to the drug’s short plasma half-life of approximately 1.5 hours, the duration of overdose effects is typically limited. For the transdermal patch, the patch should be removed immediately.
Storage
- Store at room temperature between 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F).
- Oral Solution: Store upright. Use within one month of first opening the bottle.
- Transdermal Patch: Keep patches in their sealed pouch until use. Store in the original packaging to protect from light and moisture.
- Keep all medications out of the reach of children and pets.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided may not cover all possible uses, directions, precautions, drug interactions, or adverse effects.
Reviews
“After my mother was diagnosed with Alzheimer’s, her neurologist started her on the Exelon patch. The transition from the capsules was a game-changer. The severe nausea she experienced vanished. While it hasn’t reversed her condition, we feel it has provided a noticeable plateau in her cognitive decline over the past 18 months. Her ability to engage in simple conversations and recognize family members has been preserved longer than we anticipated.” – Carol D., daughter and caregiver.
“Managing my Parkinson’s disease dementia has been challenging. The introduction of Exelon capsules was part of a broader therapy adjustment. The initial side effects were tough—significant appetite loss—but after a very slow and careful dose titration by my doctor, my body adjusted. I feel it has provided a modest but meaningful improvement in my mental clarity and ability to focus on tasks, which helps me maintain a degree of independence.” – Mark R., patient.
“As a geriatric psychiatrist, I have prescribed Exelon in its various forms for many years. It remains a cornerstone in our pharmacological arsenal for dementia. The key is careful patient selection and meticulous dose management, especially during the titration phase. The transdermal formulation has significantly improved our ability to manage tolerability. The goal is not dramatic improvement but stabilization, and in that regard, it is a valuable tool for improving quality of life for both patients and their families.” – Dr. Evelyn Shaw, MD.