[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Cholinesterase inhibitors](https://durgical.com/en/pharmacology/classes/cholinesterase-inhibitors/) › Rivastigmine [Pharmacology](https://durgical.com/en/pharmacology/) · [Cholinesterase inhibitors](https://durgical.com/en/pharmacology/classes/cholinesterase-inhibitors/) # Rivastigmine A cholinesterase inhibitor for Alzheimer dementia and the dementia of Parkinson disease, given as capsules or a skin patch. Updated 2026-11-01 - Class: [Cholinesterase inhibitors](https://durgical.com/en/pharmacology/classes/cholinesterase-inhibitors/) - Enzyme: Acetylcholinesterase and butyrylcholinesterase - ATC code: N06DA03 ✂**Acetylcholinesterase and butyrylcholinesterase**Rivastigmine ⓘ The figure shows Torpedo (electric ray) acetylcholinesterase after reaction with rivastigmine: its carbamoyl group stays bonded to the catalytic serine and its leaving phenol (NAP) remains in the gorge. **Target in 3D:** Acetylcholinesterase and butyrylcholinesterase. PDB structure 1GQR (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/1GQR) · Drag to rotate · pinch to zoom ## Mechanism of action Rivastigmine is a carbamate that enters the brain and carbamylates both acetylcholinesterase and butyrylcholinesterase. The enzyme stays blocked for hours although the drug itself leaves the blood within about an hour (a «pseudo-irreversible» inhibitor). More acetylcholine at cortical synapses eases cognitive symptoms. - Enters the brain - Carbamylates acetylcholinesterase and butyrylcholinesterase - Enzymes stay blocked for hours - Acetylcholine lasts longer; cognition improves modestly ## Pharmacokinetics **Absorption** Capsules by mouth or a daily transdermal patch, which gives steadier levels **Metabolism** Hydrolysed by cholinesterases themselves, hardly by CYP enzymes, so few drug interactions **Elimination** Metabolites in the urine **Half-life** About 1 hour in plasma after capsules, but enzyme inhibition lasts about 8 to 10 hours ## Indications - Mild to moderate dementia of the Alzheimer type [Alzheimer disease →](https://durgical.com/en/conditions/alzheimer-disease/) - Mild to moderate dementia associated with Parkinson disease [Parkinson disease →](https://durgical.com/en/conditions/parkinson-disease/) ## Adverse effects ### Common - Nausea, vomiting, diarrhoea and loss of appetite, dose-related - Weight loss - Dizziness and headache - Skin redness and itching at the patch site ### Serious (rare, important) - Dehydration from prolonged vomiting or diarrhoea - Allergic contact dermatitis or disseminated skin reactions - Worsening tremor in Parkinson disease - Bradycardia, fainting, gastrointestinal bleeding and seizures (class effects) ## Contraindications - Hypersensitivity to rivastigmine or other carbamates - Previous patch-site reaction suggesting allergic contact dermatitis, unless allergy tests are negative ## Key interactions **Metoclopramide** Added extrapyramidal effects; combination not recommended **Beta blockers, especially atenolol** Additive bradycardia and fainting **Anticholinergic drugs such as oxybutynin or tolterodine** Opposite actions; each weakens the other ## What is monitored - Weight, appetite and hydration - Heart rate and falls - Skin at patch sites - Tremor and movement in Parkinson disease ## Administration and safety - Doses are started low and raised slowly to limit vomiting; after more than three missed days the prescriber is contacted to restart at a low dose - Only one patch at a time; the old one is removed before a new one is applied - Patch site changed every day to reduce skin irritation - Capsules are taken with meals ## Nursing care - Check for an old patch before applying a new one; double patches have caused overdoses - Watch fluid intake and weight in frail older adults - Inspect patch sites and report spreading rash - Teach caregivers to report fainting, black stools or worsening tremor ## Pregnancy and breastfeeding No adequate data in pregnancy; it is used mainly in older adults. ## Memory aid RIVAstigmine has two RIVAls blocked (acetyl- and butyryl-cholinesterase) and two dementias (Alzheimer and Parkinson). ## Test yourself Think of the answer, then tap the question to see it. ## Which two enzymes does rivastigmine inhibit? Acetylcholinesterase and butyrylcholinesterase. ## Besides Alzheimer disease, which dementia is an approved use? Mild to moderate dementia associated with Parkinson disease. ## Why does rivastigmine have few CYP-based drug interactions? It is broken down mainly by cholinesterase hydrolysis, not by liver CYP enzymes. ## What is a key safety check before applying a rivastigmine patch? Make sure the previous patch has been removed, to avoid a double dose. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/rivastigmine/) ## Related drugs - [Donepezil](https://durgical.com/en/pharmacology/donepezil/) - [Galantamine](https://durgical.com/en/pharmacology/galantamine/) ## Related conditions - [Alzheimer disease](https://durgical.com/en/conditions/alzheimer-disease/) - [Parkinson disease](https://durgical.com/en/conditions/parkinson-disease/) [← Back to the class: Cholinesterase inhibitors](https://durgical.com/en/pharmacology/classes/cholinesterase-inhibitors/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - RIVASTIGMINE TARTRATE capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=52781229-ee82-43f9-a113-4419a611978d) (DailyMed (U.S. National Library of Medicine), 2026); [DailyMed - RIVASTIGMINE patch, extended release](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8b809739-8381-4cc1-ab4a-5b17ab902a3d) (DailyMed (U.S. National Library of Medicine), 2026); [Rivastigmine: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a602009.html) (MedlinePlus (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 21 (McGraw Hill, 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/rivastigmine/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/rivastigmine/