Generic Exelon

Introduction

Exelon (rivastigmine tartrate) is an acetylcholinesterase inhibitor approved for the symptomatic treatment of mild‑to‑moderate dementia associated with Alzheimer’s disease and Parkinson’s disease dementia in the United Kingdom. The medication is marketed by Janssen‑Cilag and belongs to the therapeutic groups of general health and Alzheimer’s disease management. It is available as oral capsules, orally disintegrating tablets, and a transdermal patch, allowing clinicians to tailor administration to patient needs.

What is Exelon?

Exelon is a prescription‑only medication that contains the active compound rivastigmine tartrate. It was developed to increase cerebral acetylcholine concentrations by inhibiting the enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE). Exelon is produced by Janssen‑Cilag (a Johnson & Johnson company) and is supplied in three licensed formulations in the UK:

• 1.5 mg, 3 mg, 4.5 mg, and 6 mg oral capsules
• 4.6 mg orally disintegrating tablets (ODT)
• 4.6 mg/24 h transdermal patch (applied once daily)

The transdermal system provides a steady drug delivery that can improve tolerability in patients who experience gastrointestinal adverse effects with oral dosing.

How Exelon Works

Rivastigmine is a reversible, pseudo‑irreversible inhibitor of both AChE andChE. By blocking these enzymes, the drug reduces the breakdown of acetylcholine in synaptic clefts, thereby enhancing cholinergic neurotransmission. In Alzheimer’s disease and Parkinson’s disease dementia, cholinergic pathways are selectively impaired; augmenting acetylcholine helps to alleviate cognitive symptoms such as memory loss, attention deficits, and impaired executive function.

Onset of clinical benefit typically occurs within 4–6 weeks of initiating therapy, although maximal effect may require 3–4 months of stable dosing. The drug has a relatively short plasma half‑life of 1.5–3 hours for oral formulations; the patch provides continuous delivery for up to 24 hours, resulting in smoother plasma concentrations and fewer peaks that are associated with nausea.

Conditionsated with Exelon

• Alzheimer’s disease (mild‑to‑moderate dementia) – The most common indication. NICE guideline NG97 recommends cholinesterase inhibitors as first‑line symptomatic therapy for patients with a confirmed diagnosis of mild‑to‑moderate Alzheimer’s disease.
• Parkinson’s disease dementia (PDD) – Approved for use when dementia emerges in patients with established Parkinson’s disease. Clinical trials have shown modest improvements in cognition and activities of daily living.

In UK, an estimated 850 000 people live with dementia, of which roughly 35 % have Alzheimer’s disease and 7 % have Parkinson’s disease dementia. Early pharmacological intervention with Exelon can delay functional decline and reduce caregiver burden.

Who is Exelon For?

• Adults with a documented diagnosis of mild‑to‑moderate Alzheimer’s disease confirmed by clinical assessment and, where available, neuroimaging.
• Patients with Parkinson’s disease dementia who have progressed the early, non‑demented stage of the disease.
• Individuals who can tolerate cholinergic therapy and have no contraindicating comorbidities (e.g., severe hepatic impairment or uncontrolled asthma).
• Patients who may benefit from a transdermal system, such as those with swallowing difficulties, gastrointestinal intolerance to oral tablets, or who require once‑daily dosing for adherence.

Exelon is not appropriate for patients with severe dementia, a history of hypersensitivity to rivastigmine or any excipients, or those taking medications that strongly inhibit CYP3A4/5 when using the patch (which may increase systemic exposure). Caution is also advised in patients with bradycardia, obstructive pulmonary disease, or recent myocardial infarction.

Risks, Side Effects, and Interactions

Common

• Nausea, vomiting, loss of appetite, weight loss
• Diarrhoea, abdominal pain, flatulence
• Dizziness, headache, fatigue
• Skin irritation at the patch site (redness, pruritus)

Rare

• Hallucinations or visual disturbances
• Extrapyramidal symptoms (tremor, rigidity) – more common in Parkinson’s disease patients
• Bradyarrhythmia, syncope
• Severe skin reactions (e.g., contact dermatitis, bullous eruption)

Serious

• Gastrointestinal ulceration or bleeding, especially when combined with NSAIDs or anticoagulants
• Severe weight loss leading to malnutrition
• Cardiac conduction abnormalities (e.g., atrioventricular block) in patients with pre‑existing cardiac disease

Clinically Relevant Drug‑Drug Interactions

• Anticholinergic agents (e.g., antihistamines, tricyclic antidepressants) may diminish the cognitive benefit of Exelon.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs), anticoagulants, or antiplatelet agents increase the risk of gastrointestinal bleeding.
• Beta‑blockers or calcium‑channel blockers can potentiate bradycardia when combined with Exelon, especially in the patch formulation.
• CYP3A4/5 inhibitors (e.g., ketoconazole, clarithromycin) may raise plasma rivastigmine levels from the transdermal patch and should be used with caution.

Patients should inform their healthcare professional of all concomitant medicines, including over‑the‑counter products and herbal supplements.

Practical Use: Dosing, Missed Dose, Overdose

• Oral capsule: Start with 1.5 mg twice daily; increase by 1.5 mg twice daily at 2‑week intervals to a usual maintenance dose of 3 mg twice daily (maximum 6 mg twice daily).
• Orally disintegrating tablet: Initiate at 4.6 mg once daily; may increase to 9.2 mg once daily after 4 weeks if tolerated.
• Transdermal patch: Apply a 4.6 mg/24 h patch daily to clean, dry, hair‑free skin on the upper or lower back, upper arm, or chest. Replace every 24 hours. Dose titration follows a similar schedule: start with a 4.6 mg/24 h patch for 4 weeks, then increase to 9.5 mg/24 h if needed.

Missed dose (oral): If a dose is missed by less than 12 hours, take it as soon as remembered; skip the missed dose if it is longer than 12 hours and continue with the regular schedule. Do not double‑dose.

Missed patch change: Apply a new patch immediately and discard the old one. If more than 24 hours have passed, restart the low‑dose patch (4.6 mg/24 h) for 4 weeks before increasing.

Overdose: Symptoms may include severe nausea, vomiting, muscle weakness, bradycardia, and syncope. Seek urgent medical attention. Supportive care (e.g., gastric lavage, activated charcoal) is recommended by the UK Poisons Information Service.

Precautions:

• Take oral capsules with meals to reduce gastrointestinal irritation.
• Avoid alcohol, which can exacerbate dizziness and nausea.
• Monitor body weight regularly; consider nutritional support if weight loss exceeds 5 % of baseline.
• Periodic liver function tests are advised in patients with hepatic impairment.

Buying Exelon from Our Online Pharmacy

Exelon can be purchased safely from our online pharmacy in the UK. Our service offers several advantages for patients who require reliable and discreet access to this medication:

• Affordable pricing – We source Exelon directly from licensed manufacturers, allowing us to offer prices close to the original cost price.
• Verified quality – All batches are batch‑tested and supplied by trusted, GMP‑certified overseas pharmacies.
• Guaranteed delivery – Discreet packaging with express shipping (typically 7 days) or regular airmail (~3 weeks) ensures the medication reaches you promptly.
• Online‑only convenience – Our pharmacy broker model works with internationally licensed suppliers, providing a privacy‑respecting channel for patients who have limited availability through local pharmacies or who need a cost‑effective generic alternative.

By choosing our online pharmacy, you gain access to a medication that is essential for managing dementia symptoms, without the typical financial or logistical barriers.

FAQ

• Can Exelon be taken with food?
  Yes, oral capsules and tablets should be taken with meals to minimise gastrointestinal upset. The transdermal patch is applied to clean, dry skin and does not require food considerations.

• What should I do if the patch causes skin irritation?
  Remove the patch, cleanse the area with mild soap, and allow the skin to dry. If irritation persists, rotate the application site each day or consult a healthcare professional for an alternative formulation.

• Is there a difference between the oral capsule and the orally disintegrating tablet?
  Both contain the same amount of rivastigmine tartrate, but the ODT dissolves on the tongue without water, which can be advantageous for patients with swallowing difficulties. Dosing schedules differ slightly, as noted in the Practical Use section.

• Does Exelon have a shelf life after opening the blister pack?
  Once a blister pack is opened, each capsule or tablet should be used within 30 days, stored at room temperature away from humidity and light. The patch should be applied within 7 days of removal from its protective container.

• Can I travel internationally with Exelon?
  Yes, but keep the medication in its original packaging with a clear label, carry a copy of the prescription (if required), and be aware of each country’s import regulations for prescription medicines.

• Are there any dietary restrictions while on Exelon?
  No specific restrictions, but high‑fat meals may delay absorption of the oral formulation, potentially increasing nausea. Moderation of caffeine and alcohol is advisable to reduce dizziness.

• How does the efficacy of the patch compare with oral dosing? Clinical studies have shown comparable cognitive benefits, with the patch offering lower rates of gastrointestinal side effects due to steadier plasma concentrations.

• What are the most common reasons for discontinuing Exelon?
  The primary reasons include intolerable nausea or vomiting, significant weight loss, and severe skin reactions at the patch site.

• Is Exelon approved for use in patients with severe liver disease?
  Exelon is contraindicated in severe hepatic impairment because reduced metabolism can increase systemic exposure and the risk of adverse events.

• Has the formulation of Exelon changed over time?
  The active ingredient (rivastigmine tartrate) remains unchanged; however, newer formulations such as the ODT and the transdermal patch were introduced to improve tolerability and adherence.

Glossary

Acetylcholinesterase (AChE)

An enzyme that breaks down the neurotransmitter acetylcholine in the synaptic cleft; inhibition increases acetylcholine availability for neuronal signaling.

Butyrylcholinesterase (BuChE)

A secondary cholinesterase enzyme found in plasma and peripheral tissues; rivastigmine inhibits both AChE and BuChE, broadening its therapeutic effect.

Transdermal Patch

A medicated adhesive patch that delivers a drug through the skin into systemic circulation over a defined period, providing steady plasma levels.

NICE Guideline NG97

The National Institute for Health and Care Excellence recommendation that outlines the use of cholinesterase inhibitors as first‑line treatment for mild‑to‑moderate dementia in the UK.

⚠️ Disclaimer

The information provided about Exelon is for general knowledge only. It does not replace professional medical consultation. All treatment decisions should be made under the supervision of a qualified healthcare provider. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to Exelon for individuals who may have limited availability through traditional pharmacies, prescription‑based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication.