Rivastigmine is one of the most commonly prescribed medications for Alzheimer's and Parkinson's treatment. Dentists must be mindful of contraindications with NSAIDs and steroids, as well as local anesthetic precautions, in Rivastigmine patients. Read on to learn more:
Generic Name: Rivastigmine Tartrate
Brand Name(s): Exelon
Pronunciation: ri va STIG meen
About this drug:
Rivastigmine is used to treat mild to moderate dementia of the Alzheimer's type.
It is also used to treat patients with mild to moderately severe dementia associated with Parkinson’s disease.
It does not cure Alzheimer’s or Parkinson's disease.
Dentistry-related tidbits:
NSAIDs (e.g. Aspirin, Ibuprofen, Naproxen) and steroids (e.g. Hydrocortisone) can cause GI perforation, ulceration, and bleeding, including serious bleeding in patients taking Rivastigmine. In particular, Betamethasone, Dexamethasone, Prednisone, Triamcinolone may also decrease Rivastigmine efficacy, causing extreme weakness in myasthenia gravis (must D/C Rivastigmine > 24 hours before these steroids are started).
Benzos (e.g. Clonazepam, Diazepam, Lorazepam, Midazolam), anticonvulsants (e.g. Gabapentin, Pregabalin, Carbamazepine), and Tramadol may decrease seizure threshold. Make sure to check for potential interactions before prescribing using a tool like Rx Check.
Rhinitis, sialorrhea, and coughing with bloody vomit or mucus are some oral-related side effects of Rivastigmine.
Articaine (e.g. Septocaine, Ultacan), Bupivacaine (e.g. Marcaine, Sensorcaine), Lidocaine (e.g. Xylocaine), Mepivacaine (e.g. Carbocaine, Polocaine), and Ropivacaine (e.g. Naropin) can cause bradycardia when combined with Rivastigmine. At this time, there are no restrictions for Epinephrine.
Fun facts:
Rivastigmine is available in different formulations, including oral capsules, oral solution, and transdermal patches.
Impairment of attention and memory in patients with Alzheimer’s and Parkinson’s disease is associated with significantly lower levels of acetylcholine. Rivastigmine works by blocking cholinesterase enzymes that break down acetylcholine.
Prolonged use of cholinesterase inhibitors like Rivastigmine can result in neurodegeneration increases the vulnerability for psychosis in these patients, which is why Rivastigmine is commonly paired with neuroleptics such as Quetiapine.
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