Medical Information

Rivastigmine transdermal patch is used to treat Alzheimer's disease and Parkinson's disease dementia, and its transdermal administration can reduce gastrointestinal side effects. The following provides a systematic explanation of standard usage and dosage, dosage adjustment principles, and medication requirements for special populations, with a focus on medication differences among the elderly, liver and kidney dysfunction, and other groups.

1. Standard usage and dosage

(1) Initial dose: Apply 4.6mg/24h daily for at least 4 weeks. The patch should be changed at the same time every day and applied to clean and dry upper arm or back skin.

(2) Dose escalation: If well tolerated, it can be increased to 9.5mg/24h. The maximum recommended dose is 13.3mg/24h, and it should be applied in two doses (e.g. 4.6mg in the morning and 4.6mg in the evening).

(3) Discontinue medication treatment: If the missed patch exceeds 3 days, start from the lowest dose again. The residual medicine after removal of the patch can be cleaned with oil-based lotion.

2. Medication for special populations

(1) Elderly patients: Dosage adjustment is not necessary for those over 65 years old, but close monitoring of adverse reactions such as bradycardia and syncope is necessary.

(2) Liver dysfunction: Use with caution in patients with mild to moderate damage, with the initial dose halved (2.3mg/24h). Severe liver dysfunction is prohibited.

(3) Renal insufficiency: Mild to moderate damage does not require adjustment. Patients with end-stage renal disease are recommended to start at 4.6mg/24h and increase the interval to 2 weeks.

(4) Children: Safety and efficacy have not been established for those under 18 years old, and its use is not recommended.

3. Medication precautions

(1) Skin reaction: About 20% of patients experience redness and itching at the application site. The application site should be rotated, and medication should be discontinued for severe dermatitis.

(2) Neurological system: may exacerbate tremor symptoms in Parkinson's disease. Immediate medical attention is required in case of epileptic seizures or extrapyramidal reactions.

(3) Cardiovascular risk: Individuals with a history of abnormal cardiac conduction should monitor their heart rate and avoid using beta blockers in combination.

4. Special case handling

(1) Surgical management: Discontinue use 24 hours before general anesthesia to prevent excessive cholinergic stimulation.

(2) Drug interactions: Avoid co administration with anticholinergic drugs. Combined use with memantine may enhance the therapeutic effect, and the dosage needs to be adjusted.

(3) Overdose treatment: If severe vomiting or excessive saliva secretion occurs, the patch should be removed immediately and atropine should be administered intravenously.