Rivastigmine: what it does and who it helps

Rivastigmine is a medicine used to help memory and thinking in mild to moderate Alzheimer’s disease and dementia related to Parkinson’s. It won’t cure dementia, but it can ease symptoms for months in some people — making daily life easier. It comes as pills and a skin patch; the patch often causes fewer stomach problems.

How to take rivastigmine

Oral rivastigmine usually starts low and goes up in steps. A common schedule is 1.5 mg twice daily, then 3 mg twice daily after two weeks, then 4.5 mg and finally 6 mg twice daily if tolerated (maximum 6 mg twice daily). The transdermal patch starts at 4.6 mg/24h and is often increased to 9.5 mg/24h; some people may move to higher patches under a doctor’s advice. Follow your prescriber's schedule — don’t jump doses or stop suddenly without checking with them.

Take the pills with food to reduce nausea. For the patch, apply to a dry, hairless area on the upper back, chest or upper arm and replace it every 24 hours. Rotate sites to avoid skin irritation.

Side effects, interactions, and practical tips

Most people notice mild stomach upset first: nausea, vomiting, diarrhea, and reduced appetite are common. These often improve after the dose is adjusted. Less common but important issues are slow heart rate (bradycardia), fainting, weight loss, and increased sweating. Tell your doctor if you feel dizzy, faint, or have a fast or slow heartbeat.

Watch other medicines. Drugs with anticholinergic effects (like some antihistamines, bladder meds, or sleep aids) can reduce rivastigmine’s benefit. Combining with beta-blockers or other drugs that lower heart rate may increase the risk of fainting. If you have asthma or COPD, mention that — cholinesterase inhibitors can sometimes worsen breathing problems.

Practical tips: 1) If nausea is a problem, try the patch — it usually causes less GI upset. 2) Weigh the person weekly for the first months; loss of appetite and weight can be subtle. 3) Monitor pulse and report any fainting or new lightheadedness. 4) Keep a simple daily log of sleep, eating, and behavior changes to share at follow-ups — it helps assess if the drug is working.

Finally, set realistic expectations. Improvements are often small: better attention, clearer thinking for daily tasks, or fewer behavioral spikes. If you or a loved one shows no benefit after a few months or side effects are too bad, talk to the prescriber about stopping or switching forms (pill vs patch) or trying alternative care strategies.

If you have questions about interactions with specific drugs you take, or about patch vs pill choice, ask your doctor or pharmacist — they can tailor advice to your situation and medical history.