Rivastigmine (Exelon)

Trade Name : Exelon

Novartis Pharmaceuticals Corporation

PATCH, EXTENDED RELEASE

Strength 4.6 mg/24h

RIVASTIGMINE Cholinesterase Inhibitor [EPC],Cholinesterase Inhibitors [MoA]

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GNH India is WHO GDP and ISO 9001 2015 Certified Pharmaceutical Wholesaler/ Supplier/ Exporters/ Importer from India of Rivastigmine (Exelon) which is also known as Exelon and Manufactured by Novartis Pharmaceuticals Corporation. It is available in strength of 4.6 mg/24h per ml. Read more

Rivastigmine (Exelon) is supplied for Tenders/ Emergency imports/ Un - licensed, Specials, Orphan drug/ Name patient line/ RLD supplies/ Reference listed drugs/ Comparator Drug/ Bio-Similar/ Innovator samples For Clinical trials. Click to know price. Read less

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About GNH

No data

EXELON PATCH is an acetylcholinesterase inhibitor indicated for treatment of:

Mild, moderate, and severe dementia of the Alzheimeru2019s type (AD). ()n
Mild-to-moderate dementia associated with Parkinsonu2019s disease (PD). ()

No data

Apply patch on intact skin for a 24-hour period; replace with a new patch every 24 hours. (, )
Initial Dose:
Dose Titration ():
Mild-to-Moderate Alzheimeru2019s Disease and Parkinsonu2019s Disease Dementia:
Severe Alzheimeru2019s Disease:
For treatment interruption longer than 3 days, retitrate dosage starting at 4.6 mg per 24 hours. ()
Consider dose adjustments in patients with ():ntttttttttn

EXELON PATCH is available in 3 strengths. Each patch has a beige backing layer labeled as either:
Patch: 4.6 mg/24 hours or 9.5 mg/24 hours or 13.3 mg/24 hours ()

EXELON PATCH is contraindicated in patients with:
Isolated cases of generalized skin reactions have been described in postmarketing experience .

Known hypersensitivity to rivastigmine, other carbamate derivatives, or other components of the formulation. ()
History of application-site reactions with rivastigmine transdermal patch suggestive of allergic contact dermatitis. (, )

No data

Hospitalization and, rarely, death have been reported due to application of multiple patches at same time. Ensure patients or caregivers receive instruction on proper dosing and administration. ()n
Gastrointestinal Adverse Reactions:
Application-site reactions may occur with the patch form of rivastigmine. Discontinue treatment if application-site reactions spread beyond the patch size, if there is evidence of a more intense local reaction (e.g., increasing erythema, edema, papules, vesicles), and if symptoms do not significantly improve within 48 hours after patch removal. ()

The following adverse reactions are described below and elsewhere in the labeling:
Most common adverse reactions (less than 5% and higher than with placebo): Nausea, vomiting, and diarrhea. ()

Concomitant use with metoclopramide, beta-blockers, or cholinomimetics and anticholinergic medications is not recommended. (, , )

No data

Overdose with EXELON PATCH has been reported in the postmarketing setting . Overdoses have occurred from application of more than one patch at one time and not removing the previous dayu2019s patch before applying a new patch. The symptoms reported in these overdose cases are similar to those seen in cases of overdose associated with rivastigmine oral formulations.
Because strategies for the management of overdose are continually evolving, it is advisable to contact a Poison Control Center to determine the latest recommendations for the management of an overdose of any drug. As rivastigmine has a plasma half-life of about 3.4u00a0hours after patch administration and a duration of acetylcholinesterase inhibition of about 9u00a0hours, it is recommended that in cases of asymptomatic overdose the patch should be immediately removed and no further patch should be applied for the next 24u00a0hours.
As in any case of overdose, general supportive measures should be utilized.
Overdosage with cholinesterase inhibitors can result in cholinergic crisis characterized by severe nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory depression, and convulsions. Increasing muscle weakness is a possibility and may result in death if respiratory muscles are involved. Atypical responses in blood pressure and heart rate have been reported with other drugs that increase cholinergic activity when coadministered with quaternary anticholinergics such as glycopyrrolate. Additional symptoms associated with rivastigmine overdose are diarrhea, abdominal pain, dizziness, tremor, headache, somnolence, confusional state, hyperhidrosis, hypertension, hallucinations and malaise. Due to the short plasma elimination half-life of rivastigmine after patch administration, dialysis (hemodialysis, peritoneal dialysis, or hemofiltration) would not be clinically indicated in the event of an overdose.
In overdose accompanied by severe nausea and vomiting, the use of antiemetics should be considered. A fatal outcome has rarely been reported with rivastigmine overdose.

EXELON PATCH (rivastigmineu00a0transdermalu00a0system)u00a0contains rivastigmine, a reversible cholinesterase inhibitor known chemically as (S)-3-[1-(dimethylamino) ethyl]phenyl ethylmethylcarbamate. It has an empirical formula of CHNO as the base and a molecular weight of 250.34 g/mol (as the base). Rivastigmine is a viscous, clear, and colorless to yellow to very slightly brown liquid that is sparingly soluble in water and very soluble in ethanol, acetonitrile, n-octanol and ethyl acetate.
The distribution coefficient at 37u00b0C in n-octanol/phosphate buffer solution pH 7 is 4.27.
EXELON PATCH is for transdermal administration. The patch is a 4-layer laminate containing the backing layer, drug matrix, adhesive matrix and overlapping release liner (see Figure 1). The release liner is removed and discarded prior to use.
Figure 1: Cross Section of the EXELON PATCH
Excipients within the formulation include acrylic copolymer, poly(butylmethacrylate, methylmethacrylate), silicone adhesive applied to a flexible polymer backing film, silicone oil, and vitamin E.

No data

Carcinogenesis
In oral carcinogenicity studies conducted at doses up to 1.1 mg/kg/day in rats and 1.6 mg/kg/day in mice, rivastigmine was not carcinogenic.
In a dermal carcinogenicity study conducted at doses up to 0.75 mg base/kg/day in mice, rivastigmine was not carcinogenic. The mean rivastigmine plasma exposure (AUC) at this dose was less than that in humans at the maximum recommended human dose (13.3 mg/24 hours).
Mutagenesis
Rivastigmine was clastogenic in chromosomal aberration assays in mammalian cells in the presence, but not the absence, of metabolic activation. Rivastigmine was negative in an in vitro bacterial reverse mutation (Ames) assay, an HGPRT assay, and in an mouse micronucleus test.
Impairment of Fertility
No fertility or reproduction studies of dermal rivastigmine have been conducted in animals. Rivastigmine had no effect on fertility or reproductive performance in rats at oral doses up to 1.1 mg/kg/day.

The effectiveness of the EXELON PATCH in dementia of the Alzheimeru2019s type and dementia associated with Parkinsonu2019s disease was based on the results of 3 controlled trials of EXELON PATCH in patients with Alzheimeru2019s disease (Studies 1, 2, and 3) (see below); 3 controlled trials of oral rivastigmine in patients with dementia of the Alzheimeru2019s type; and 1 controlled trial of oral rivastigmine in patients with dementia associated with Parkinsonu2019s disease. See the prescribing information for oral rivastigmine for details of the four studies of oral rivastigmine.
Mild-to-Moderate Alzheimeru2019s Disease
International 24-Week Study of EXELON PATCH in Dementia of the Alzheimeru2019s Type (Study 1)
This study was a randomized double-blind, double dummy clinical investigation in patients with Alzheimeru2019s disease [diagnosed by NINCDS-ADRDA and DSM-IV criteria, Mini-Mental Status Examination (MMSE) score greater than or equal to 10 and less than or equal to 20] (Study 1). The mean age of patients participating in this trial was 74u00a0years with a range of 50 to 90u00a0years. Approximately 67% of patients were women, and 33% were men. The racial distribution was Caucasian 75%, Black 1%, Asian 9%, and other races 15%.
The effectiveness of the EXELON PATCH was evaluated in Study 1 using a dual outcome assessment strategy, evaluating for changes in both cognitive performance and overall clinical effect.
The ability of the EXELON PATCH to improve cognitive performance was assessed with the cognitive subscale of the Alzheimeru2019s Disease Assessment Scale (ADAS-Cog), a multi-item instrument that has been extensively validated in longitudinal cohorts of Alzheimeru2019s-disease patients. The ADAS-Cog examines selected aspects of cognitive performance including elements of memory, orientation, attention, reasoning, language, and praxis. The ADAS-Cog scoring range is from 0 to 70, with higher scores indicating greater cognitive impairment. Elderly normal adults may score as low as 0 or 1, but it is not unusual for non-demented adults to score slightly higher.
The ability of the EXELON PATCH to produce an overall clinical effect was assessed using the Alzheimeru2019s Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC). The ADCS-CGIC is a more standardized form of the Clinician's Interview-Based Impression of Change-Plus (CIBIC-Plus) and is also scored as a 7-point categorical rating; scores range from 1, indicating u201cmarkedly improved,u201d to 4, indicating u201cno change,u201d to 7, indicating u201cmarked worsening.u201d
In Study 1, 1195 patients were randomized to 1 of the following 4 treatments: EXELON PATCH 9.5u00a0mg/24u00a0hours, EXELON PATCH 17.4u00a0mg/24u00a0hours, EXELON Capsules in a dose of 6u00a0mg twice daily, or placebo. This 24-week study was divided into a 16-week titration phase followed by an 8-week maintenance phase. In the active treatment arms of this study, doses below the target dose were permitted during the maintenance phase in the event of poor tolerability.
Figure 3 illustrates the time course for the change from baseline in ADAS-Cog scores for all 4 treatment groups over the 24-week study. At 24 weeks, the mean differences in the ADAS-Cog change scores for the EXELON-treated patients compared to the patients on placebo, were 1.8, 2.9, and 1.8 units for the EXELON PATCH 9.5 mg/24 hours, EXELON PATCH 17.4 mg/24 hours, and EXELON Capsule 6 mg twice daily groups, respectively. The difference between each of these groups and placebo was statistically significant. Although a slight improvement was observed with the 17.4 mg/24 hours patch compared to the 9.5 mg/24 hours patch on this outcome measure, no meaningful difference between the two was seen on the global evaluation (see Figure 4).
Figure 4 presents the distribution of patientsu2019 scores on the ADCS-CGIC for all 4 treatment groups.u00a0u00a0At 24 weeks, the mean difference in the ADCS-CGIC scores for the comparison of patients in each of the EXELON-treated groups with the patients on placebo was 0.2 units. The difference between each of these groups and placebo was statistically significant.
International 48-Week Study of EXELON PATCH in Dementia of the Alzheimeru2019s Type (Study 2)
This study was a randomized double-blind clinical investigation in patients with Alzheimeru2019s disease [diagnosed by NINCDS-ADRDA and DSM-IV criteria, Mini-Mental State Examination (MMSE) score greater than or equal to 10 and less than or equal to 24] (Study 2). The mean age of patients participating in this trial was 76 years with a range of 50 to 85 years. Approximately 65% of patients were women and 35% were men. The racial distribution was approximately Caucasian 97%, Black 2%, Asian 0.5%, and other races 1%. Approximately 27% of the patients were taking memantine throughout the entire duration of the study.
Alzheimeru2019s disease patients who received 24 to 48 weeks open-label treatment with EXELON PATCH 9.5 mg/24 hours and who demonstrated functional and cognitive decline were randomized into treatment with either EXELON PATCH 9.5 mg/24 hours or EXELON PATCH 13.3 mg/24 hours in a 48-week, double-blind treatment phase. Functional decline was assessed by the investigator and cognitive decline was defined as a decrease in the MMSE score of greater than or equal to 2 points from the previous visit or a decrease of greater than or equal to 3 points from baseline.
Study 2 was designed to compare the efficacy of EXELON PATCH 13.3 mg/ 24 hours versus that of EXELON PATCH 9.5 mg/24 hours during the 48-week, double-blind treatment phase.
The ability of the EXELON PATCH 13.3 mg/24 hours to improve cognitive performance over that provided by the EXELON PATCH 9.5 mg/24 hours was assessed by the cognitive subscale of the Alzheimeru2019s Disease Assessment Scale (ADAS-Cog) .
The ability of the EXELON PATCH 13.3 mg/24 hours to improve overall function versus that provided by EXELON PATCH 9.5 mg/24 hours was assessed by the instrumental subscale of the Alzheimeru2019s Disease Cooperative Study Activities of Daily Living (ADCS-IADL). The ADCS-IADL subscale is composed of items 7 to 23 of the caregiver-based ADCS-ADL scale. The ADCS-IADL assesses activities such as those necessary for communicating and interacting with other people, maintaining a household, and conducting hobbies and interests. A sum score is calculated by adding the scores of the individual items and can range from 0 to 56, with higher scores indicating less impairment.
Out of a total of 1584 patients enrolled in the initial open-label phase of the study, 567 patients were classified as decliners and were randomized into the 48-week double-blind treatment phase of the study. Two hundred eighty-seven (287) patients entered the 9.5 mg/24 hours EXELON PATCH treatment group and 280 patients entered the 13.3 mg/24 hours EXELON PATCH treatment group.
Figure 5 illustrates the time course for the mean change from double-blind baseline in ADCS-IADL scores for each treatment group over the course of the 48-week treatment phase of the study. Decline in the mean ADCS-IADL score from the double-blind baseline for the Intent to Treatu2013Last Observation Carried Forward (ITT-LOCF) analysis was less at each timepoint in the 13.3 mg/24 hour EXELON PATCH treatment group than in the 9.5 mg/24 hours EXELON PATCH treatment group. The 13.3 mg/24 hours dose was statistically significantly superior to the 9.5mg/24 hours dose at weeks 16, 24, 32, and 48 (primary endpoint).
Figure 6 illustrates the time course for the mean change from double-blind baseline in ADAS-Cog scores for both treatment groups over the 48-week treatment phase. The between-treatment group difference for EXELON PATCH 13.3 mg/24 hours versus EXELON PATCH 9.5 mg/24 hours was nominally statistically significant at week 24 (p = 0.027), but not at week 48 (p = 0.227), which was the primary endpoint.
Severe Alzheimeru2019s Disease
24-Week United States Study With EXELON PATCH in Severe Alzheimeru2019s Disease (Study 3)
This was a 24-week randomized double-blind, clinical investigation in patients with severe Alzheimeru2019s disease [diagnosed by NINCDS-ADRDA and DSM-IV criteria, Mini-Mental State Examination (MMSE) score greater than or equal to 3 and less than or equal to 12]. The mean age of patients participating in this trial was 78 years with a range of 51 to 96 years with 62% aged greater than 75 years. Approximately 65% of patients were women and 35% were men. The racial distribution was approximately Caucasian 87%, Black 7%, Asian 1%, and other races 5%. Patients on a stable dose of memantine were permitted to enter the study. Approximately 61% of the patients in each treatment group were taking memantine throughout the entire duration of the study.
The study was designed to compare the efficacy of EXELON PATCH 13.3 mg/ 24 hours versus that of EXELON PATCH 4.6 mg/24 hours during the 24-week double-blind treatment phase.
The ability of the 13.3 mg/24 hours EXELON PATCH to improve cognitive performance versus that provided by the 4.6 mg/24 hours EXELON PATCH was assessed with the Severe Impairment Battery (SIB) which uses a validated 40-item scale developed for the evaluation of the severity of cognitive dysfunction in more advanced AD patients. The domains assessed included social interaction, memory, language, attention, orientation, praxis, visuospatial ability, construction, and orienting to name. The SIB was scored from 0 to 100, with higher scores reflecting higher levels of cognitive ability.
The ability of the 13.3 mg/ 24 hours EXELON PATCH to improve overall function versus that provided by the 4.6 mg/24 hours EXELON PATCH was assessed with the Alzheimeru2019s Disease Cooperative Study-Activities of Daily Living-Severe Impairment Version (ADCS-ADL-SIV) which is a caregiver-based ADL scale composed of 19 items developed for use in clinical studies of dementia. It is designed to assess the patient's performance of both basic and instrumental activities of daily living such as those necessary for personal care, communicating and interacting with other people, maintaining a household, conducting hobbies and interests, and making judgments and decisions. A sum score is calculated by adding the scores of the individual items and can range from 0 to 54, with higher scores indicating less functional impairment.
In this study, 716 patients were randomized into one of the following treatments: EXELON PATCH 13.3 mg/24 hours or EXELON PATCH 4.6 mg/24 hours in a 1:1 ratio. This 24-week study was divided into an 8-week titration phase followed by a 16-week maintenance phase. In the active treatment arms of this study, temporary dose adjustments below the target dose were permitted during the titration and maintenance phase in the event of poor tolerability.
Figure 7 illustrates the time course for the mean change from baseline SIB scores for each treatment group over the course of the 24-week treatment phase of the study. Decline in the mean SIB score from the baseline for the Modified Full Analysis Set (MFAS)-Last Observation Carried Forward (LOCF) analysis was less at each timepoint in the 13.3 mg/24 hours EXELON PATCH treatment group than in the 4.6 mg/24 hours EXELON PATCH treatment group. The 13.3 mg/24 hours dose was statistically significantly superior to the 4.6 mg/24 hours dose at weeks 16 and 24 (primary endpoint).
Figure 8 illustrates the time course for the mean change from baseline in ADCS-ADL-SIV scores for each treatment group over the course of the 24-week treatment phase of the study. Decline in the mean ADCS-ADL-SIV score from baseline for the MFAS-LOCF analysis was less at each timepoint in the 13.3 mg/24 hours EXELON PATCH treatment group than in the 4.6 mg/24 hours EXELON PATCH treatment group. The 13.3 mg/24 hours dose was statistically significantly superior to the 4.6 mg/24 hours dose at weeks 16 and 24 (primary endpoint).

EXELON PATCH: 4.6 mg/24 hours
Each patch of 5u00a0cm contains 9u00a0mg rivastigmine base with release rate of 4.6u00a0mg/24u00a0hours.
nttu00a0u00a0u00a0u00a0u00a0ntCarton of 30u2026u2026u2026u2026u2026u2026u2026u2026u2026NDC 0078-0501-15
EXELON PATCH: 9.5 mg/24 hours
Each patch of 10u00a0cm contains 18u00a0mg rivastigmine base with release rate ofu00a09.5u00a0mg/24u00a0hours.
nttu00a0u00a0u00a0u00a0u00a0ntCarton of 30u2026u2026u2026u2026u2026u2026u2026u2026u2026..NDC 0078-0502-15
EXELON PATCH: 13.3 mg/24 hours
Each patch of 15u00a0cm contains 27u00a0mg rivastigmine base with release rate of 13.3u00a0mg/24u00a0hours.
nttu00a0u00a0u00a0u00a0u00a0ntCarton of 30u2026u2026u2026u2026u2026u2026u2026u2026u2026NDC 0078-0503-15
Store at 25u00b0C (77u00b0F); excursions permitted to 15u00b0C to 30u00b0Cu00a0(59u00b0F-86u00b0F) [see USP Controlled Room Temperature].u00a0u00a0Keep EXELON PATCH in the individual sealed pouch until use.u00a0u00a0Each pouch contains 1 patch.u00a0u00a0Used systems should be folded, with the adhesive surfaces pressed together, and discarded safely.u00a0u00a0

Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use).
Importance of Correct Usage
Inform patients or caregivers of the importance of applying the correct dose on the correct part of the body. They should be instructed to rotate the application site in order to minimize skin irritation. The same site should not be used within 14 days. The previous dayu2019s patch must be removed before applying a new patch to a different skin location. EXELON PATCH should be replaced every 24 hours and the time of day should be consistent. It may be helpful for this to be part of a daily routine, such as the daily bath or shower. Only 1 patch should be worn at a time .
Instruct patients or caregivers to avoid exposure of the patch to external heat sources (excessive sunlight, saunas, solariums) for long periods of time.
Instruct patients who have missed a dose to apply a new patch immediately. They may apply the next patch at the usual time the next day. Instruct patients to not apply 2 patches to make up for 1 missed.
Inform the patient or caregiver to contact the physician for retitration instructions if treatment has been interrupted.
Discarding Used Patches
Instruct patients or caregivers to fold the patch in half after use, return the used patch to its original pouch, and discard it out of the reach and sight of children and pets. They should also be informed that drug still remains in the patch after 24-hour usage. They should be instructed to avoid eye contact and to wash their hands after handling the patch. In case of accidental contact with the eyes, or if their eyes become red after handling the patch, they should be instructed to rinse immediately with plenty of water and to seek medical advice if symptoms do not resolve .
Gastrointestinal Adverse Reactions
Inform patients or caregivers of the potential gastrointestinal adverse reactions such as nausea, vomiting, and diarrhea, including the possibility of dehydration due to these symptoms. Explain that EXELON PATCH may affect the patientu2019s appetite and/or the patientu2019s weight. Patients and caregivers should be instructed to look for these adverse reactions, in particular when treatment is initiated or the dose is increased. Instruct patients and caregivers to inform a physician if these adverse reactions persist .
Skin Reactions
Inform patients or caregivers about the potential for allergic contact dermatitis reactions to occur. Patients or caregivers should be instructed to inform a physician if application-site reactions spread beyond the patch size, if there is evidence of a more intense local reaction (e.g., increasing erythema, edema, papules, vesicles) and if symptoms do not significantly improve within 48 hours after patch removal .
Concomitant Use of Drugs With Cholinergic Action
Inform patients or caregivers that while wearing EXELON PATCH, patients should not be taking EXELON Capsules or EXELON Oral Solution or other drugs with cholinergic effects .
Pregnancy
Advise patients to notify their healthcare provider if they are pregnant or plan to become pregnant.
Distributed by:Novartis Pharmaceuticals CorporationEast Hanover, New Jersey 07936
T2018-140

No data

Instructions for Use
EXELON (ECS-u2018el-on) PATCH
(rivastigmine transdermal system)
You will need the following supplies (See Figure A):
EXELON PATCH is supplied in cartons containing 30 patches (See Figure A)
Figure A
Using EXELON PATCH:
Step 1. Choose an area to apply the EXELON PATCH (See Figure B).
Figure B
The diagram represents areas on the body where EXELON PATCH may be applied. Only 1 patch should be worn at a time. Do not apply multiple patches to the body.
Step 2. Remove the EXELON PATCH from the pouch (See Figure C).
Carefully cut the pouch along the dotted line to open and remove the EXELON PATCH. Save the pouch for later use.
Figure C
Step 3. Remove 1 side of the adhesive liner (See Figure D).
Figure D
Step 4. Apply the EXELON PATCH to your skin (See Figure E).
Figure E
Figure F
Step 5: Wash your hands with soap and water right away.
Note:
Removing your EXELON PATCH:
Step 6. Remove the EXELON PATCH from the skin (See Figure G).
Figure G
Throwing away the used EXELON PATCH:
Step 7. Throw away the used EXELON PATCH (See Figure H).
Figure H
Step 8: Wash your hands with soap and water right away.
This Instructions for Use have been approved by the U.S. Food and Drug Administration.
Distributed by:Novartis Pharmaceuticals CorporationEast Hanover, New Jersey 07936
u00a9 Novartis
T2018-142December 2018

PRINCIPAL DISPLAY PANEL
Package Label u2013 4.6 mg / 24 hours
Rx Onlynttu00a0u00a0u00a0u00a0u00a0ntnttu00a0u00a0u00a0u00a0u00a0ntNDC 0078-0501-15
EXELONu00ae Patch
(rivastigmine transdermal system)
Each System Delivers 4.6 mg/24 hours
For Transdermal Use Only
Contains 30 Systems
nttu00a0u00a0u00a0u00a0u00a0nt
nttu00a0u00a0u00a0u00a0u00a0nt

PRINCIPAL DISPLAY PANEL
Package Label u2013 9.5 mg / 24 hours
Rx Onlynttu00a0u00a0u00a0u00a0u00a0ntnttu00a0u00a0u00a0u00a0u00a0ntNDC 0078-0502-15
EXELONu00ae Patch
(rivastigmine transdermal system)
Each System Delivers 9.5 mg/24 hours
For Transdermal Use Only
Contains 30 Systems

PRINCIPAL DISPLAY PANEL
Package Label u2013 13.3 mg / 24 hours
Rx Onlynttu00a0u00a0u00a0u00a0u00a0ntnttu00a0u00a0u00a0u00a0u00a0ntNDC 0078-0503-15
EXELONu00ae Patch
(rivastigmine transdermal system)
Each System Delivers 13.3 mg/24 hours
For Transdermal Use Only
Contains 30 Systems

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Rivastigmine (Exelon)

Trade Name : Exelon

PATCH, EXTENDED RELEASE

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Rivastigmine (Exelon)

Trade Name : Exelon

PATCH, EXTENDED RELEASE

Delivery Process

Product information is meant for

Disclaimer

Trade Marks displayed in compliance with provisions of: Trademark Act, 1999 u/s 30 and 30 (1) of "Fair use"

Packaging and Delivery

About GNH

Similar Products

Desogestrel And Ethinyl Estradiol (Emoquette)

Diphenoxylate Hydrochloride And Atropine Sulfate (Diphenoxylate Hydrochloride And Atropine Sulfate)

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