Exelon

1 What is Exelon?

Brand: Exelon

Generic: Rivastigmine Tartrate

Exelon is usually given in patients with myasthenia gravis in order to control muscular fatigue and other symptoms. Myasthenia gravis is an autoimmune disease, most commonly caused by antibodies to acetylcholine receptors.

About 15% of patients have a thymoma, most of the other displaying thymic follicular hyperplasia. The most evident symptom is fatigable muscle weakness; movement is initially strong but rapidly weakens as muscle use continues. The first symptoms are usually intermittent ptosis or diplopia, but the weakness of chewing, swallowing, speaking or limb movement also occurs.

The goals of treatment are to minimize the activity of acetylcholine at remaining receptors in the neuromuscular junctions and to limit or abolish the immunological attack on motor end plates.

The duration of action of acetylcholine is prolonged by inhibiting acetylcholinesterase. The most commonly used anticholinesterase drug is pyridostigmine.

The immunological treatment of myasthenia comprises intravenous immunoglobulin, plasma exchange, corticosteroid treatment, and pharmacological immunosuppression treatment. In addition, thymectomy may improve overall prognosis but awaits clinical trial confirmation.

Antimyathenics are available only with your doctor's prescription in various dosage forms:

  • Capsule
  • Capsule, Extended Release
  • Tablet
  • Tablet, Extended Release
  • Tablet, Disintegrating
  • Solution
  • Syrup

2 What to Know Before Using

Before using Exelon, you must know all about the risks and complications associated with it. The suitable drug therapy is chosen by a doctor with the active participation of the patient.

There are some important factors such as drug interactions, the presence of any metabolic impairment, history of hypersensitivity reaction, pregnancy, lactation etc. that may alter the desired therapeutic effects of a medicine.

Sometimes the presence of other health disorders affects the beneficial effects of this medicine and even may cause serious toxic effects.

Thus, you should tell your doctor if you have any other medical problems, especially:

In addition, certain medicines should not be used along with this medicine. It is always recommended to consult with your doctor if you are in need of some other medications or even any over-the-counter medicine for another health problem in order to avoid unwanted toxic effects.

3 Proper Usage

To use Exelon properly, you must follow all instructions given by your doctor. The dosage schedule and the duration of drug therapy depend on the particular medical problem for which you are going to use this medicine. The therapeutic dose may also vary with the patient’s condition or requirement and the strength of the medicine as well.

  • Symptom control: by pyridostigmine (60-120 mg per oral up to 6 times daily; but not exceeding 1.2 g/day).
  • Immunosuppression: relapses are treated with prednisolone. Initially, 5 mg is given on alternate days. The dose can be increased by 5 mg/week up to 1 mg/kg on each treatment day. Steroids may be combined with azathioprine (2.5 mg/kg/day) or weekly methotrexate. IV methylprednisolone has a role.

If you miss a dose of this medicine, take it as soon as possible. But when it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule as prescribed.

Further, it is advised to store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children. However, outdated medicines should be disposed of by an appropriate way.

4 Precautions to Take

Before using Exelon, there are some precautions you must take. Firstly, regular visits to your doctor are recommended to check the prognosis while undergoing any drug therapy. Additionally, the following guidelines should be followed:

  • Treatment should be initiated in the hospital. Usually, it is necessary to continue treatment for months or years, risking adverse effects.
  • Some drugs (e.g. penicillamine) can trigger an antibody-mediated myasthenic syndrome that may persist after drug withdrawal. Other drugs, especially aminoglycosides and quinolones, may exacerbate the neuromuscular blockade and should be avoided in patients with myasthenia.
  • Forced vital capacity should be monitored. Ventilator support is needed if vital capacity is <20 ml/kg.
  • An overdose of anticholinesterase drugs may cause a ‘cholinergic crisis’ due to depolarization block of motor end plates, with muscle fasciculation, paralysis, pallor sweating, excessive salivation and small pupils.
  • Muscarinic side-effects, including diarrhea and colic, may be controlled by propantheline.
  • Treatment with plasmapheresis or IV Immunoglobulin is recommended in myasthenic crisis.

5 Potential Side Effects

As with many medications, there are several potential side effects associated with Exelon. These side effects usually go away during the treatment episode as your body adjusts to the medicine.

Your healthcare professional may advise you about the ways how to prevent or reduce those unwanted side effects.

Sometimes you may need to consult with the doctor immediately if you notice any of the following toxic effects, especially:

  • Severe diarrhea
  • Severe vomiting
  • Nausea
  • Clumsiness or unsteadiness
  • Convulsions
  • Watering of mouth
  • Slurred speech
  • Nervousness
  • Severe stomach cramps or pain
  • Shortness of breath
  • Troubled breathing
  • Wheezing
  • Chest tightness
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