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
coadministered 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
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