For many patients the transdermal rivastigmine (Exelon) patch is an effective therapy for Alzheimer's disease. However, serious adverse effects including death have occurred when errors have occurred while using these patches.


Medication errors associated with adverse effects to rivastigmine:

(1) wearing 2 or more patches at the same time (usually caused by not removing a patch before placing another)

(2) cutting the patch into pieces before applying it (which could happen if not careful opening the pouch enclosure with scissors)

(3) prescribing too high a dose for the patient's body weight

(4) prescribing the drug despite comorbid conditions that may increase the risk of adverse side effects (cardiac conduction defects, COPD, asthma, urinary obstruction, peptic ulcer disease, seizure, etc)


Patients who weigh less than 50 kilograms are at increased risk for dose-related adverse effects. Significant weight loss during therapy without reducing the dose can also result in toxicity.


Although not mentioned, applying heat over the patch could increase release and absorption (based on experience with the Fentanyl patch).


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