Overview
Rivastigmine is a cholinesterase inhibitor used for the treatment of mild to moderate dementia of the Alzheimer’s type and dementia associated with Parkinson’s disease. It works by increasing the levels of acetylcholine in the brain, which helps improve thinking, memory, and cognitive function.

Mechanism of Action
It reversibly binds to and inhibits both acetylcholinesterase and butyrylcholinesterase, enzymes responsible for breaking down the neurotransmitter acetylcholine. By preventing this breakdown, rivastigmine increases the concentration of acetylcholine at the cholinergic synapses, thereby facilitating neurotransmission and temporarily improving cognitive symptoms.

Dosage and Administration
It is available in oral capsules, liquid solutions, and transdermal patches. The oral dose usually starts at 1.5 mg twice daily and can be gradually increased. The patch is often preferred as it provides continuous delivery and may have fewer gastrointestinal side effects. It should be applied to clean, dry, hairless skin once daily.

Side Effects
Common side effects include nausea, vomiting, loss of appetite, weight loss, and diarrhea, especially when starting the medication or increasing the dose. The transdermal patch may cause application site skin reactions.

Contraindications
It is contraindicated in patients with a known hypersensitivity to rivastigmine or other carbamate derivatives. Caution is advised in patients with a history of peptic ulcers, sick sinus syndrome, or severe asthma.

Pregnancy and Lactation
It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether it is excreted in human milk, so caution should be exercised when administered to a nursing woman.