Mentazac (Rivastigmine)

• Rivastigmine acts on the cholinergic pathway to improve cognition in dementia-related conditions.
• Alzheimer's disease: improves cognition, memory and daily functioning, and may delay functional decline in patients with mild to moderate disease.
• Parkinson's disease dementia: helps mitigate cognitive impairment and supports activities of daily living in individuals with Parkinson’s disease–related dementia.
• Dementia of mixed etiology: can be used under specialist guidance when cholinergic deficiency contributes to cognitive symptoms, offering potential benefit in mixed‑type dementia.

• Rivastigmine reversibly inhibits both acetylcholinesterase and butyrylcholinesterase enzymes, reducing the breakdown of acetylcholine in synaptic clefts. By increasing extracellular acetylcholine concentrations, it enhances cholinergic neurotransmission in cortical and hippocampal regions, which are implicated in memory and cognition. The dual inhibition provides broader enzyme coverage compared with agents that target acetylcholinesterase alone, supporting improved cognitive function in dementia.

Rivastigmine may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea
• Vomiting
• Diarrhea
• Loss of appetite

Serious or Rare Side Effects

• Bradycardia or heart block
• Severe gastrointestinal bleeding
• Skin reactions such as rash or urticaria

• Before initiating Rivastigmine therapy, several safety considerations should be reviewed.
• Cardiac assessment: evaluate for bradyarrhythmias or conduction disorders before use.
• Gastrointestinal monitoring: watch for persistent nausea, vomiting or diarrhea that may lead to dehydration.
• Weight management: monitor body weight regularly, especially in patients with reduced appetite.
• Drug interactions: review concomitant anticholinergic or cholinergic agents that may alter efficacy or increase risk.
• Store at ambient temperature: keep below 25°C in the original packaging, protected from moisture and light.

Rivastigmine can interact with other medicines, affecting its safety or effectiveness.

Major Interactions (Avoid)

• Co‑administration with other cholinesterase inhibitors: may cause excessive cholinergic activity and severe gastrointestinal or cardiac effects.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): can increase rivastigmine plasma levels and heighten risk of adverse reactions.

Moderate Interactions (Monitor Closely)

• Anticholinergic drugs (e.g., diphenhydramine, atropine): may reduce therapeutic benefit.
• Beta‑blockers or calcium‑channel blockers: may exacerbate bradycardia; monitor heart rate.
• NSAIDs or anticoagulants: increase risk of gastrointestinal bleeding; assess bleeding risk.