ZEYZELF TWICE WEEKLY

Zeyzelf twice weekly transdermal patches should be applied twice weekly on fixed days (after four and three days, respectively) (please see also Method of administration). Treatment should be initiated and supervised by a physician experienced in the diagnosis and treatment of Alzheimer’s dementia.

Diagnosis should be made according to current guidelines. Similar to any treatment initiated in patients with dementia, therapy with rivastigmine should only be started if a caregiver is available to regularly administer and monitor the treatment.

6 mg/24 h. 5 mg/24 h, the daily recommended effective dose, which should be continued for as long as the patient continues to demonstrate therapeutic benefit. 5 mg/24 h is the recommended daily effective dose which should be continued for as long as the patient continues to demonstrate therapeutic benefit.

g. 1). 3 mg/24 h dose strength cannot be achieved with Zeyzelf twice weekly. 3 mg/24 h strength are available. The clinical benefit of rivastigmine should be reassessed on a regular basis. Discontinuation should also be considered when evidence of a therapeutic effect at the optimal dose is no longer present.

Treatment should be temporarily interrupted if gastrointestinal adverse reactions are observed until these adverse reactions resolve. Transdermal patch treatment can be resumed at the same dose if treatment is not interrupted for more than three days.

6 mg/24 h. 6 mg/24 h transdermal patches. 6 mg/24 h transdermal patches. 5 mg/24 h transdermal patches. 6 mg/24 h transdermal patches is recommended. 5 mg/24 h transdermal patches. 5 mg/24 h, which is the recommended effective dose. It is recommended to apply the first transdermal patch on the day following the last oral dose.

Special populations • Paediatric population:

There is no relevant use of rivastigmine in the paediatric population in the treatment of Alzheimer’s disease. 4). They may experience more adverse reactions and may be more likely to discontinue due to adverse reactions. • Hepatic impairment: Due to increased exposure in mild to moderate hepatic impairment as observed with the oral formulation, dosing recommendations to titrate according to individual tolerability should be closely followed.

Patients with clinically significant hepatic impairment may experience more dose-dependent adverse reactions. Patients with severe hepatic impairment have not been studied. 2). 2). Method of administration Zeyzelf twice weekly is for transdermal use.

Summary of the safety profile Application site skin reactions (usually mild to moderate application site erythema), are the most frequent adverse reactions observed with the use of rivastigmine transdermal patch. The next most common adverse reactions are gastrointestinal in nature including nausea and vomiting.

Adverse reactions in Table 1 are listed according to MedDRA system organ class and frequency category. Frequency categories are defined using the following convention: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000); not known (cannot be estimated from the available data).

Tabulated list of adverse reactions Table 1 displays the adverse reactions reported in 1,670 patients with Alzheimer’s dementia treated in randomised, double-blind, placebo and active-controlled clinical studies with rivastigmine transdermal patches for a duration of 24-48 weeks and from post-marketing data.

g. g. 3 mg/24 h or placebo, suggesting a dose effect relationship. 3 mg/24 h transdermal patches than with placebo. The following adverse reactions have only been observed with rivastigmine capsules and oral solution and not in clinical studies with rivastigmine transdermal patches: malaise, confusion, sweating increased (common); duodenal ulcers, angina pectoris (rare); gastrointestinal haemorrhage (very rare); and some cases of severe vomiting were associated with oesophageal rupture (not known).

Skin irritation In a comparative bioavailability study performed with multiple patch applications (over a period of 11 days) to 58 healthy male subjects aged between 18 and 50 years, most of the observed application site reactions were rated with score 1 (“minimal erythema, barely perceptible”) and score 2 (“definite erythema, readily visible; minimal oedema or minimal papular response”) according to the classification suggested by the EMA guideline (EMA/CPMP/EWP/280/96 Corr1).

Zeyzelf® twice weekly transdermal patches are multiday patches. Care should be exercised and application of more than one patch at the same time should be avoided. The incidence and severity of adverse reactions generally increase with increasing doses, particularly at dose changes.

6 mg/24 h. 9). Most cases of misuse of the medicinal product and dosing errors have involved not removing the old patch when putting on a new one and the use of multiple patches at the same time. 2). 8). These adverse reactions occur more commonly in women.

Patients who show signs or symptoms of dehydration resulting from prolonged vomiting or diarrhoea can be managed with intravenous fluids and dose reduction or discontinuation if recognised and treated promptly. Dehydration can be associated with serious outcomes.

Weight loss Patients with Alzheimer’s disease may lose weight whilst taking cholinesterase inhibitors, including rivastigmine. The patient’s weight should be monitored during therapy with rivastigmine transdermal patches. Bradycardia Electrocardiogram QT prolongation may occur in patients treated with certain cholinesterase inhibitor products including rivastigmine.

Rivastigmine may cause bradycardia which constitutes a risk factor in the occurrence of torsade de pointes, predominantly in patients with risk factors. Caution is advised in patients with pre-existing, or a family history of, QTc prolongation or at higher risk of developing torsade de pointes; for example, those with uncompensated heart failure, recent myocardial infarction, bradyarrhythmias, a predisposition to hypokalaemia or hypomagnesaemia, or concomitant use with medicinal products known to induce QT prolongation and/or torsade de pointes.

8). 8); • to patients predisposed to urinary obstruction and seizures because cholinomimetics may induce or exacerbate these diseases; • to patients with a history of asthma or obstructive pulmonary disease. Skin application site reactions Skin application site reactions may occur with rivastigmine patch and are usually mild or moderate in intensity.

1. 4).