OVERDOSE
Because strategies for the management of overdose
are continually evolving, it is advisable to contact a Poison
Control Center to determine the latest recommendations for
the management of an overdose of any drug.
As Exelon® (rivastigmine tartrate) has a short plasma
half-life of about one hour and a moderate duration of
acetylcholinesterase inhibition of 8-10 hours, it is recommended
that in cases of asymptomatic overdoses, no further dose
of Exelon should be administered for the next 24 hours.
As in any case of overdose, general supportive measures
should be utilized. Overdosage with cholinesterase inhibitors
can result in cholinergic crisis characterized by severe
nausea, vomiting, salivation, sweating, bradycardia, hypotension,
respiratory depression, collapse and convulsions. Increasing
muscle weakness is a possibility and may result in death
if respiratory muscles are involved. Atypical responses
in blood pressure and heart rate have been reported with
other drugs that increase cholinergic activity when co-administered
with quaternary anticholinergics such as glycopyrrolate.
Due to the short half-life of Exelon, dialysis (hemodialysis,
peritoneal dialysis, or hemofiltration) would not be clinically
indicated in the event of an overdose.
In overdoses accompanied by severe nausea and vomiting,
the use of antiemetics should be considered. In a documented
case of a 46 mg overdose with Exelon, the patient experienced
vomiting, incontinence, hypertension, psychomotor retardation,
and loss of consciousness. The patient fully recovered
within 24 hours and conservative management was all that
was required for treatment.
CONTRAINDICATIONS
Exelon® (rivastigmine tartrate) is contraindicated
in patients with known hypersensitivity to rivastigmine,
other carbamate derivatives or other components of the
formulation (see
DESCRIPTION
).
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