Rivastigmine and galantamine

Rivastigmine and galantamine

Drug monograph · NCLEX study reference
Trade names	Exelon, Razadyne
Therapeutic class	Anti-Alzheimer
Pharmacologic class	Cholinesterase inhibitors
Onset / peak / duration	Effect over weeks.
Half-life / level	Short to moderate; level not routine.
Routes	PO (oral), Transdermal
High-alert (ISMP)	No
Black box warning	None
Antidote / reversal	Atropine for severe cholinergic effects.
Pregnancy / lactation	Not typically used.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Rivastigmine and galantamine (brand names Exelon, Razadyne) — Anti-Alzheimer; Cholinesterase inhibitors.

Identification

• Therapeutic class: Anti-Alzheimer.
• Pharmacologic class: Cholinesterase inhibitors.

Pharmacology

• Mechanism of action: Increase acetylcholine; rivastigmine also inhibits butyrylcholinesterase and has a patch form.
• Onset / peak / duration: Effect over weeks.
• Half-life / therapeutic level: Short to moderate; level not routine.

Clinical use

• Indications: Alzheimer dementia; rivastigmine also for Parkinson dementia.
• Usual dose, route, frequency: Rivastigmine PO twice daily or transdermal daily; galantamine PO or ER.
• Maximum dose / adjustments: Titrate slowly; restart titration if therapy is interrupted.

Safety

• Contraindications: Hypersensitivity.
• Black box warning: None.
• Interactions: Anticholinergics, beta blockers, NSAIDs.
• Pregnancy / lactation: Not typically used.
• High-alert: No.

Adverse effects

• Common side effects: Nausea, vomiting, weight loss, dizziness.
• Serious effects to report: Bradycardia, GI bleeding, severe vomiting; rotate patch sites to prevent skin reactions.
• Antidote / reversal: Atropine for severe cholinergic effects.

Nursing process

• Assessment before administration: Heart rate, weight, GI history.
• Interventions during therapy: Rotate patch sites; remove old patch before applying new.
• Monitor: Cognition, weight, heart rate.
• Evaluation / expected outcome: Slowed decline.

Patient teaching

• Patient teaching: Apply only one patch; report severe nausea.
• Notify provider if: Fainting, slow heartbeat, persistent vomiting.
• Administration tips: With food; one patch at a time.