Nervopan (Rivastigmine)

• Rivastigmine is used to treat cognitive decline in neurodegenerative disorders that affect memory and executive function.
• Alzheimer’s disease: improves cognition and functional abilities in mild to moderate stages.
• Parkinson’s disease dementia: helps maintain cognitive function and daily activities.
• Dementia associated with Lewy body disease: may provide symptomatic benefit for attention and memory.
• Mild to moderate dementia of mixed aetiology: supports overall cognitive performance and daily living tasks.

• Rivastigmine reversibly inhibits both acetylcholinesterase and butyrylcholinesterase, enzymes responsible for breaking down acetylcholine in the central nervous system. By reducing enzymatic degradation, it increases synaptic acetylcholine concentrations, enhancing cholinergic neurotransmission that is deficient in Alzheimer’s disease and Parkinson’s disease dementia, thereby improving cognitive function and related symptoms.

Rivastigmine may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Nausea and vomiting
• Diarrhea or loose stools
• Loss of appetite
• Weight loss
• Dizziness or light‑headedness
• Abdominal pain

Serious or Rare Side Effects

• Severe gastrointestinal bleeding
• Bradycardia or syncope
• Hepatic dysfunction (elevated liver enzymes)
• Severe skin reactions such as rash or urticaria
• Respiratory difficulties (bronchospasm)
• Muscle weakness or neuromuscular junction effects

• When prescribing Rivastigmine, several safety considerations should be observed.
• Dose titration: start low and increase gradually to minimise gastrointestinal discomfort.
• Renal impairment: adjust dosage in patients with severe renal dysfunction.
• Hepatic impairment: use with caution in moderate to severe liver disease.
• Cardiovascular disease: monitor for bradycardia, syncope, or arrhythmias.
• Concomitant anticholinergic drugs: avoid combined use as they may counteract therapeutic effects.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Rivastigmine can interact with other medicines, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• Anticholinergic agents: may diminish Rivastigmine’s cognitive benefits.
• Beta‑blockers: combined use can exacerbate bradycardia.
• Other cholinesterase inhibitors: additive cholinergic effects may lead to severe adverse reactions.

Moderate Interactions (Monitor Closely):\n- Anticoagulants (e.g., warfarin): increased risk of gastrointestinal bleeding.

• Non‑steroidal anti‑inflammatory drugs (NSAIDs): may aggravate GI irritation.
• Selective serotonin reuptake inhibitors (SSRIs): monitor for heightened nausea or gastrointestinal upset.