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A REVIEW OF RIVASTIGMINE (EXELON) IN TREATING PARKINSON'S DISEASE

 

 

What is rivastigmine and how does it work? 

 

  • Rivastigmine is a well-established treatment for memory and thinking problems in Parkinson’s disease dementia. It often brings small improvements or slows decline, usually without making movement worse, and is available as a pill or a patch.

 

  • Exelon increases the amount of a chemical in the brain (acetylcholine) that is important for memory by slowing down how fast it is broken down.

 

 

How effective is rivastigmine according to research?

 

  • Around 20% of patients had clinically meaningful improvement in overall condition versus about 14% on placebo

 

  • If about 10–12 people like your loved one take the drug under the conditions studied, one would be expected to have a noticeable benefit over what would happen without treatment.

 

How much did rivastigmine make a clinically meaningful difference?

 

  • Studies have shown clear, but modest improvement

    • Benefits typically include better memory, attention, and ability to do everyday activities, but do not cure dementia or Parkinson’s disease itself

 

  • It may help some but not all symptoms, and effects are generally not dramatic.

    • For example, one major 24-week trial in PD dementia showed an average improvement of about 2 points on cognitive tests compared to a slight decline in those taking placebo.

       

  • Exelon does not worsen Parkinson’s movement symptoms for most people.

 

  • Caregivers often notice if the medicine helps, that stopping it suddenly can lead to a noticeable decline in memory and daily functioning.

 

What are chances of side effects?

 

  • If about 10–12 people like your loved one take the drug under the conditions studied, one would be expected to  experience a harmful side‐effect.

 

 

​​​​​​​What are the side effects?

 

  • The most common side effects are nausea, vomiting, loss of appetite, and weight loss, especially when starting or increasing the dose.

 

  • The skin patch seems to have fewer stomach side effects and is often easier for patients and caregivers.

 

  • Less commonly, serious harms include: slowing of heart rate, fainting,, gastrointestinal bleeding or worsening of existing ulcers (especially in those on NSAIDs or with prior ulcer disease.) 

 

  • Many clinicians consider fainting/slow heart beat plus cascading risk of falls and injury in frail elders as one of the biggest harms — because the downstream consequences (falls, fractures, head injury, hospitalization) can be life-changing in older adults.

 

 

 
important points

 

  • The trade‐off means: if your loved one is somewhat healthy, early in the disease, and able to tolerate treatment, the drug might make a modest difference. But if your loved one is frail, has many other illnesses, or is very advanced in dementia, the likelihood of meaningful benefit is lower and the risk of harm higher.

 

  • It should be started and supervised by a healthcare professional, and caregivers should help monitor for both side effects and signs of benefit. Side effects are usually mild but should be reported to your doctor who  may lower the dose or switch how the medicine is taken.

 

  • In clinical trials, initial improvements in memory and thinking were seen within about 4 to 6 weeks, once a therapeutic dose was reached.

 

  • The full study duration showing benefits usually ranged up to 24 weeks (6 months), with some patients continuing beyond this with ongoing benefit.

 

  • Exelon treatment typically starts at a low dose and increases gradually over several weeks.

 

  • If you miss several doses or stop the medicine, talk to your doctor before starting again.