Package Insert: Information for the User

Exelon 4.6mg/24h Transdermal Patch

Exelon 9.5mg/24h Transdermal Patch

Exelon 13.3mg/24h Transdermal Patch

rivastigmina

Read this package insert carefully before starting to use this medication, as it contains important information for you.

• Keep this package insert, as you may need to read it again.

• If you have any questions, consult your doctor, pharmacist, or nurse.
• This medication has been prescribed only for you, and you should not give it to others who have the same symptoms as you, as it may harm them.
• If you experience any adverse effects, consult your doctor, pharmacist, or nurse, even if they are not listed in this package insert.See section4.

1.What is Exelon and for what it is used

2.What you need to know before starting to use Exelon

3.How to use Exelon

4.Possible adverse effects

5.Storage of Exelon

6.Contents of the package and additional information

The active ingredient of Exelon is rivastigmine.

Rivastigmine belongs to the group of cholinesterase inhibitors. In patients with Alzheimer's disease, certain nerve cells die in the brain, resulting in low levels of acetylcholine neurotransmitters (a substance that allows nerve cells to communicate with each other). Rivastigmine acts by blocking the enzymes that break down acetylcholine: acetylcholinesterase and butyrylcholinesterase. By blocking these enzymes, Exelon allows an increase in acetylcholine in the brain, helping to reduce the symptoms of Alzheimer's disease.

Exelon is used for the treatment of adult patients with mild to moderately severe Alzheimer's disease, a progressive brain disorder that gradually affects memory, intellectual capacity, and behavior.

Do not use Exelon

• if you are allergic to rivastigmine (the active ingredient in Exelon) or to any of the other ingredients (listed in section 6).
• if you have ever had an allergic reaction to a similar medication (carbamate derivatives).
• if you have a skin reaction that spreads beyond the size of the patch, if there is a more intense local reaction (such as blisters, increased skin inflammation, swelling) and if there is no improvement within 48 hours after removing the transdermal patch.

If you find yourself in any of these situations, inform your doctor and do not use Exelon transdermal patches.

Warnings and precautions

Consult your doctor before starting to use Exelon:

• if you have or have had any irregular or slow heart rhythm.

• if you have or have had any active stomach ulcer.
• if you have or have had any difficulty urinating.
• if you have or have had any seizures.
• if you have or have had any severe respiratory disease or asthma.
• if you suffer from tremors.
• if you have a low body weight.
• if you have gastrointestinal reactions such as dizziness (nausea), dizziness (vomiting), and diarrhea. You may become dehydrated (loss of a large amount of fluid) if vomiting or diarrhea is prolonged.
• if you have liver problems (hepatic insufficiency).

If you find yourself in any of these situations, your doctor may consider the need for closer monitoring while you are being treated.

If you have not used the patches for more than three days, do not apply another one without consulting your doctor first.

Children and adolescents

Exelon should not be used in pediatric patients for the treatment of Alzheimer's disease.

Other medications and Exelon

Inform your doctor or pharmacist if you are taking, have taken recently, or may need to take any other medication.

Exelon may interfere with anticholinergic medications, some of which are used to relieve stomach cramps or spasms (e.g. diciclomina), for the treatment of Parkinson's disease (e.g. amantadine), or to prevent motion sickness (e.g. difenhidramine, escopolamina, or meclizina).

Exelon transdermal patches should not be administered at the same time as metoclopramide (a medication used to relieve or prevent nausea and vomiting). Taking the two medications together may cause problems such as stiffness in the limbs and hand tremors.

If you need to undergo surgery while using Exelon transdermal patches, inform your doctor that you are using them, as they may excessively potentiate the effects of some anesthetic muscle relaxants.

Care should be taken when using Exelon transdermal patches with beta blockers (medications such as atenolol used to treat hypertension, angina, and other heart conditions). Taking the two medications together may cause complications such as a decrease in heart rate (bradycardia) that may lead to fainting or loss of consciousness.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, or if you think you may be pregnant, consult your doctor or pharmacist before using this medication.

If you are pregnant, it is necessary to evaluate the benefits of using Exelon against the possible adverse effects on the fetus. Exelon should not be used during pregnancy unless it is clearly necessary.

You should not breastfeed during your treatment with Exelon transdermal patches.

Driving and operating machinery

Your doctor will inform you if your condition allows you to drive or use machinery safely. Exelon transdermal patches may cause dizziness and severe confusion. If you feel dizzy or confused, do not drive, operate machinery, or perform other tasks that require your attention.

Follow exactly the administration instructions for Exelon transdermal patches as indicated by your doctor. If in doubt, consult your doctor, pharmacist, or nurse again.

IMPORTANT:

• Remove the previous patch before putting on a new one.
• Only one patch per day.
• Do not cut the patch into pieces.
• Press firmly the patch against the skin with the palm of your hand for at least 30seconds.

How to start treatment

Your doctor will indicate the most suitable dose of Exelon transdermal patch for your case.

• Normally, treatment starts with Exelon 4.6mg/24h.
• The usual recommended daily dose is Exelon 9.5mg/24h. If this dose is well tolerated, your doctor may consider increasing the dose to 13.3mg/24h.
• Only wear one Exelon patch at the same time and replace the patch with a new one every 24hours.

Your doctor may adjust the dose during treatment depending on your individual needs.

If you have not used the patches for more than three days, do not put on a new one without consulting your doctor. Treatment with a transdermal patch can be restarted at the same dose if treatment is not interrupted for more than three days. Otherwise, your doctor will have you restart your treatment with Exelon 4.6mg/24h.

Exelon can be used with food, drink, and alcohol.

Where to place your Exelon transdermal patch

• Beforeputting on a patch, make sure the skin is clean, dry, and hair-free, without powders, oils, moisturizers, or lotions that may prevent the patch from sticking well to the skin, without cuts, redness, or irritation.
• Remove any existing patch carefully before putting on a new one.This may expose you to an excessive amount of this medication, which could be potentially hazardous.
• Put ononly ONEpatch per day inONEof the possible areas as shown in the following diagrams:

• upper left or upper right arm
• upper left or upper right chest(avoiding breasts in women)
• upper left or upper right back
• lower left or lower right back

Each time you change the patch, remove the previous day's patch before putting on a new patch in a different area of the skin (for example, one day on the right side of the body and the next day on the left side; or one day on the upper part of the body and the next day on the lower part). Wait at least 14 days to put a new patch in the same area of the skin again.

Howto apply your Exelon transdermal patch

Exelon patches arethin, opaque plastic and stick to the skin. Each patch is in a protective envelope that protects it until you put it on. Do not open the envelope or remove the patch until you are ready to put it on.

You must wear the patch continuously until you change it for a new one. When putting on a new patch, you can try different areas to find the ones that are most comfortable and where clothing does not rub against the patch.

How to remove your Exelon transdermal patch

Gently pull one of the edges of the patch to remove it slowly from the skin. If there are any remaining adhesive residues on the skin, soak the area with warm water and mild soap or use baby oil to remove it. Do not use alcohol or other solvents (nail polish removers or other solvents).

After removing the patch, wash your hands with soap and water. If you come into contact with your eyes or if your eyes become red after handling the patch, wash immediately with plenty of water and seek medical advice if the symptoms do not resolve.

Can you wear your Exelon transdermal patch when bathing, swimming, or exposing yourself to the sun?

• Bathing, swimming, or showering should not affect the patch. Make sure it does not come off partially while doing these activities.

• Do not expose the patch to an external heat source (e.g. excessive sunlight, sauna, solarium) for long periods of time.

What to do if a patch falls off

If a patch falls off, put on a new one for the rest of the day and change it the next day at the usual time.

When and for how long you should wear your Exelon transdermal patch

• To benefit from your treatment, you must put on a new patch every day, preferably at the same time.
• Only wear one Exelon patch at the same time and replace the patch with a new one every 24hours.

If you use more Exelon than you should

If you accidentally put on more than one patch, remove all the patches from the skin and inform your doctor. You may need medical attention. Some people who have taken accidentally high doses of Exelon orally have experienced nausea, vomiting, diarrhea, high blood pressure, and hallucinations.They may also experience bradycardia and dizziness.

If you forget to use Exelon

If you realize you have forgotten to put on a patch, put it on immediately. The next day, put on the next patch at the usual time. Do not put on two patches to compensate for the one you forgot.

If you interrupt treatment with Exelon

Inform your doctor or pharmacist if you stop using the patches.

If you have any other questions about the use of this medication, ask your doctor or pharmacist.

Like all medicines, Exelon transdermal patches may cause side effects, although not everyone will experience them.

You may experience side effects more frequently when you start treatment or when your dose is increased. Side effects usually fade as your body gets used to the medicine.

If you notice any of the following serious side effects, remove the patch and inform your doctor immediately.

Frequent(may affect up to 1 in 10 people)

• Loss of appetite
• Sensation of dizziness
• Sensation of agitation or numbness
• Urinary incontinence (inability to stop urinating properly).

Poorly frequent(may affect up to 1 in 100 people)

• Heart rhythm problems such as slow heart rate
• Seeing things that do not exist (hallucinations)
• Stomach ulcer
• Dehydration (loss of a large amount of fluid)
• Hyperactivity (high level of activity, restlessness)
• Aggression

Rare(may affect up to 1 in 1,000 people)

• Falls

Very rare(may affect up to 1 in 10,000 people)

• Stiffness of arms and legs
• Trembling in the hands

Unknown(cannot be estimated from available data)

• Allergic reaction where the patch was applied, such as blisters or skin inflammation
• Worsening of Parkinson's disease symptoms – such as tremor, stiffness, and difficulty moving
• Inflammation of the pancreas – symptoms include upper stomach pain, often accompanied by nausea or vomiting
• Irregular heart rhythm or rapid heart rate
• High blood pressure
• Seizures (convulsions)

• Liver disorders (yellowing of the skin, yellowing of the white of the eyes, abnormal darkening of the urine, or unexplained nausea, vomiting, fatigue, and loss of appetite)
• Changes in liver function tests

• Anxiety
• Nightmares

If you notice any of the side effects listed above, remove the patch and inform your doctor immediately.

Other side effects experienced with Exelon capsules or oral solution and that may occur with patches:

Frequent(may affect up to 1 in 10 people)

• Excessive saliva
• Loss of appetite
• Sensation of agitation
• Sensation of general discomfort
• Trembling or sensation of confusion
• Increased sweating

Poorly frequent(may affect up to 1 in 100 people)

• Irregular heart rhythm (e.g. rapid heart rate)
• Difficulty sleeping
• Accidental falls

Rare(may affect up to 1 in 1,000 people)

• Seizures (convulsions)
• Ulcer in the intestine
• Chest pain – likely caused by a heart spasm

Very rare(may affect up to 1 in 10,000 people)

• High blood pressure
• Inflammation of the pancreas – symptoms include severe upper stomach pain, often accompanied by nausea or vomiting

• Gastrointestinal bleeding – manifested as blood in the stool or vomiting blood
• Seeing things that do not exist (hallucinations)
• Some people who have been severely nauseated (vomiting) have had a tear in the tube that connects their mouth to their stomach (esophagus)

Reporting side effects

If you experience any type of side effect, consult your doctor, pharmacist, or nurse, even if it is a possible side effect that does not appear in this prospectus.You can also report them directly through the national notification system included in theAppendixV. By reporting side effects, you can contribute to providing more information about the safety of this medicine.

• Keep this medication out of the sight and reach of children.

• Do not use this medication after the expiration date that appears on the box and on the overwrap after CAD/EXP. The expiration date is the last day of the month indicated.

• Do not store above 25°C.
• Store the transdermal patch inside the overwrap until use.
• Do not use any patch if you observe that it is damaged or shows signs of manipulation.
• After removing a patch, fold it in half with the adhesive side inward and press. After disposing of the patch, ensure it is out of the reach of children. After removing the patch, do not touch your eyes, and wash your hands thoroughly with water and soap. If your household waste is disposed of by incineration, you may dispose of the patch in your household waste. If not, take used patches to the pharmacy, preferably in the original packaging.

Exelon Composition

-The active ingredient is rivastigmine.

-Exelon 4.6mg/24h transdermal patch: Each patch releasing 4.6mg of rivastigmine in 24hours, measures 5cm2and contains 9mg of rivastigmine.

-Exelon 9.5mg/24h transdermal patch: Each patch releasing 9.5mg of rivastigmine in 24hours, measures 10cm2and contains 18mg of rivastigmine.

-Exelon 13.3mg/24h transdermal patch: Each patch releasing 13.3mg of rivastigmine in 24hours, measures 15cm2and contains 27mg of rivastigmine.

-The other components arepolyethylene terephthalate lacquer, alpha tocopherol, poly-(butylmethacrylate, methylmethacrylate), acrylic copolymer, silicone oil, dimethicone, polyester film coated with fluoropolymer.

Appearance of the product and contents of the pack

Thin transdermal patch composed of three layers. The outer layer is beige and marked with:

-“Exelon”,“4.6mg/24h”and“AMCX”.

-“Exelon”,“9.5mg/24h”and“BHDI”.

-“Exelon”,“13.3mg/24h”and“CNFU”.

Each carton contains a transdermal patch.

Exelon 4.6mg/24h transdermal patch and Exelon 9.5mg/24h transdermal patch are available in cartons containing 7, 30 or 42sheets and multiple cartons containing 60, 84 or 90sheets.

Exelon 13.3mg/24htransdermal patches are available in cartons containing 7 or 30sheets and multiple cartons containing 60 or 90sheets.

Only some pack sizes may be marketed.

Marketing Authorisation Holder

Novartis Europharm Limited

Vista Building

Elm Park, Merrion Road

Dublin 4

Ireland

Manufacturer

Novartis Pharma GmbH

Roonstraße 25

D-90429Nürnberg

Germany

For further information about this medicinal product, please contact the local representative of the marketing authorisation holder:

Last update of the summary of product characteristics:

Other sources of information

The detailed information on this medicinal product is available on the website of the European Medicines Agency:http://www.ema.europa.eu