Switching from Oral Rivastigmine (Exelon) to the Transdermal Patch in a Patient with Alzheimer's Disease

 

Patient selection: AD receiving a stable dose of Exelon capsules or oral solution

Current Daily Exelon Dose	Transdermal Patch
< 6 mg per day	4.6 mg (5 cm)
6 to 12 mg	9.5 mg (10 cm)

 

It is essential the patient's caregiver be aware of how to use the transdermal patch.

 

Instructions for application of transdermal rivastigmine:

(1) Start the first patch on the day after the last oral dose.

(2) Apply the patch to clean, dry, intact, hairless and healthy skin.

(3) Do not apply a patch to skin that is moist or has recently be treated with power, cream or lotion.

(4) Do not have more than 1 patch on the patient at one time. Always remove an old patch before placing a new one.

(5) Change the patch every 24 hours, preferrably at the same time of day.

(6) Do not use a patch with a damaged pouch.

(7) Do not apply a patch that is damaged, folded sharply or cut.

(8) Remove the patch if the patient shows sign of adverse reaction and contact the patient's physician.

(9) Do not apply the patch to exactly the same area of skin where the last patch was in place. It is recommended not reuse a site for at least 14 days.

(10) If a patch falls off because of bathing, showering or other cause, do not try to tape it back in place. Apply a new patch to dry skin and change it the next day according to the routine schedule.

(11) Avoid applying the patch where it might be rubbed by tight clothing.

(12) If the patch is repeatedly removed by the patient, select a site that is less accessible.

(13) Inspect the skin where a patch has been in place for signs of irritation or contact allergy.

(14) Store new and dispose of old patches where they cannot be accessed by children or pets.

 

Common places to apply the patch:

(1) outer surface of left upper arm near shoulder

(2) outer surface of right upper arm near shoulder

(3) left chest just below the clavicle

(4) right chest just below the clavicle

(5) left upper back over the scapula

(6) right upper back over the scapula

(7) left lower back

(8) right lower back