Rivastigmine Hexal

Treatment with Rivastigmine Hexal should be initiated and supervised by a doctor who has experience in the diagnosis and treatment of Alzheimer’s disease or dementia in patients with Parkinson’s disease. Treatment should only be started if a caregiver is available who will regularly monitor the use of Rivastigmine Hexal by the patient. Treatment should continue as long as the medicine has a benefit, but the dose can be reduced or treatment interrupted if the patient has side effects.

Rivastigmine Hexal should be given twice a day, with morning and evening meals. The capsules should be swallowed whole. The starting dose is 1.5 mg twice a day. In patients who tolerate this dose, it can be increased in 1.5-mg steps no more frequently than every two weeks, to a regular dose of 3 to 6 mg twice a day. The highest tolerated dose should be used to get the maximum benefit, but the dose should not exceed 6 mg twice a day.

The active substance in Rivastigmine Hexal, rivastigmine, is an antidementia medicine. In patients with Alzheimer’s dementia or dementia due to Parkinson’s disease, certain nerve cells die in the brain, resulting in low levels of the neurotransmitter acetylcholine (a chemical that allows nerve cells to communicate with each other). Rivastigmine works by blocking the enzymes that break down acetylcholine: acetylcholinesterase and butyrylcholinesterase. By blocking these enzymes, Rivastigmine Hexal allows levels of acetylcholine to be increased in the brain, helping to reduce the symptoms of Alzheimer’s dementia and dementia due to Parkinson’s disease.

The European Commission granted a marketing authorisation valid throughout the EU to Hexal AG for Rivastigmine Hexal on 11 December 2009. The marketing authorisation is valid for five years, after which it can be renewed.

Rivastigmine Hexal is used for the treatment of patients with mild to moderately severe Alzheimer’s dementia, a progressive brain disorder that gradually affects memory, intellectual ability and behaviour. Rivastigmine Hexal is also used to treat mild to moderately severe dementia in patients with Parkinson’s disease.

The medicine can only be obtained with a prescription.

The Committee for Medicinal Products for Human Use (CHMP) concluded that Rivastigmine Hexal has a modest effectiveness in treating the symptoms of Alzheimer’s dementia, although this does reflect an important benefit in some patients. The Committee initially concluded that for the treatment of dementia due to Parkinson’s disease, Rivastigmine Hexal’s benefits did not outweigh its risks. However, following a re-examination of this opinion, the Committee concluded that the medicine’s modest effectiveness could also be of benefit to some patients.

Therefore, the Committee decided that Rivastigmine Hexal’s benefits are greater than its risks for the treatment of mild to moderately severe Alzheimer’s dementia and mild to moderately severe dementia in patients with idiopathic Parkinson’s disease. The Committee recommended that Rivastigmine Hexal be given marketing authorisation.

Rivastigmine Hexal is a medicine containing the active substance rivastigmine. It is available as capsules (yellow: 1.5 mg; orange: 3 mg; red: 4.5 mg; red and orange: 6 mg) and as an oral solution (2 mg/ml).

This medicine is the same as the capsules and oral solution of Exelon, a medicine that is already authorised in the European Union (EU). The company that makes Exelon has agreed that its scientific data can be used for Rivastigmine Hexal (‘informed consent’).

Rivastigmine Hexal has been studied in three main studies involving 2,126 patients with mild to moderately severe Alzheimer’s disease. Rivastigmine Hexal was also studied in 541 patients with dementia due to Parkinson’s disease. All of the studies lasted six months and compared the effects of Rivastigmine Hexal with those of placebo (a dummy treatment). The main measures of effectiveness were the change in symptoms in two main areas: cognitive (the ability to think, learn and remember) and global (a combination of several areas including general function, cognitive symptoms, behaviour and the ability to carry out everyday activities).

An additional study in 27 patients was used to show that Rivastigmine Hexal capsules and oral solution produced similar levels of the active substance in the blood.

The types of side effects seen with Rivastigmine Hexal depend on the type of dementia it is being used to treat. Overall, the most common side effects include nausea (feeling sick, seen in 38 patients in 100) and vomiting (seen in 23 patients in 100), particularly during the phase when the dose of Rivastigmine Hexal is being increased. For the full list of all side effects reported with Rivastigmine Hexal, see the package leaflet.

Rivastigmine Hexal must not be used in people who are hypersensitive (allergic) to rivastigmine, other carbamate derivatives or any of the other ingredients. It must also not be used in patients who are suspected to have had an allergic reaction called ‘allergic contact dermatitis’ to the Exelon patch in the past.