Presentation
6 mg capsule
Role
- Management of anticholinergic delirium.
- Oral therapy for ongoing management of protracted anticholinergic delirium after initial parenteral physostigmine.
Consultation with a clinical toxicologist is recommended through the local toxicology service or Poisons Information Centre 13 11 26.
Dose
6-12mg PO TDS1
Stocking recommendations
| Tertiary centre | Regional centre | Rural centre | Remote centre |
|---|---|---|---|
| 56 x 6mg capsules | 56 x 6mg capsules | 0 – 56 x 6mg capsules | 0 – 56 x 6mg capsules |
Rationale
Rivastigmine is a safe and effective antidote for anticholinergic delirium. It can be used as an ongoing oral therapy after initial parenteral physostigmine or as initial therapy in the absence of physostigmine. It may reduce the need for sedation to achieve behavioural control. It does not shorten the duration of delirium.
Precautions
Avoid in patients with
- asthma/chronic obstructive pulmonary disease
- cardiovascular disease
- peripheral vascular disease
- bradycardia
Excessive amounts of rivastigmine causes predictable cholinergic toxicity.
Rarely, rivastigmine use can be associated with seizures, if they occur, further doses should not be given.
References
- Chiew AL, Holford AG, Chan BS, Isoardi KZ. Rivastigmine for the management of anticholinergic delirium. Clinical Toxicology. 2024 Feb 1;62(2):82-7.
Disclaimer
Fact sheet developed by Queensland Poisons Information Centre.
This fact sheet is about the use of these antidotes in Australia, and may not apply to other countries. Children’s Health Queensland Hospital and Health Service cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this fact sheet.