When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to rivastigmine, including an allergic skin reaction to the patch.

How to Use This Medicine:
Patch

• Your doctor will tell you how many patches to use, where to apply them, and how often to apply them. Do not use more patches or apply them more often than your doctor tells you to.
• Change the patch at the same time each day. Remove the old patch before you apply a new one.
• Do not remove the patch from the pouch until you are ready to use it. Open the pouch by carefully cutting on the dotted line. Do not cut the patch. Save the pouch to use when you throw away the patch.
• Wash your hands with soap and water before and after applying a patch. Do not touch your eyes after you touch the patch.
• The patient instructions will show the body areas where you can wear the patch. This patch is usually put on the upper or lower back, upper arm, or chest. Do not put a new patch in the exact same spot for at least 14 days.
• Apply the patch to clean, dry, and hairless skin. Do not put cream, lotion, or powder on the area where the patch will be placed.Do not put the patch over burns, cuts, or irritated skin. Do not put the patch on an area where it could be rubbed off by tight clothing.
• Do not expose the patch to heating pads, electric blankets, saunas, hot tubs, direct sunlight, or other sources of heat for long periods of time.
• Put on a new patch if the old one falls off. Do not put the old one back on. Do not use tape or a bandage to hold a patch that is loose.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Missed dose: If you forget to wear or change a patch, put one on as soon as you can. If it is almost time to put on your next patch, wait until then to apply a new patch and skip the one you missed. Do not apply extra patches to make up for a missed dose. Call your doctor right away if you do not wear a patch for 3 days in a row or longer. You may need to go back to a lower dose.
• Store the patches at room temperature in a closed container, away from heat, moisture, and direct light.
• Fold the used patch in half with the sticky sides together. Put the used patch in the pouch that it came in. Throw it away so that children or pets cannot get to it. You will also need to throw away patches after the expiration date has passed.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines can affect how rivastigmine works. Tell your doctor if you are using any of the following:
  
  • Metoclopramide, oxybutynin, tolterodine
  • Beta-blocker medicine (including atenolol)
  • NSAID pain or arthritis medicine (including aspirin, celecoxib, diclofenac, ibuprofen, naproxen)

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, heart disease, heart rhythm problems, asthma or lung disease, or a history of stomach ulcers or seizures.
• This medicine may cause the following problems:
  
  • Stomach or bowel problems
  • Serious skin reactions
• Always remove the old patch before you put on a new one. If you wear more than 1 patch at the same time, you will get too much medicine. This can cause serious side effects.
• This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
• Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Bloody or black stools, vomiting of blood or material that looks like coffee grounds
• Decrease in how much or how often you urinate, difficult or painful urination
• Seizures, tremors, twitching or muscle movements you cannot control
• Slow or uneven heartbeat

If you notice these less serious side effects, talk with your doctor:

• Headache, dizziness
• Loss of appetite, weight loss
• Nausea, vomiting, diarrhea
• Redness, itching, or blisters where the patch is applied

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088