Drug-disease interactions are similar with CHE-Is and represent an increase in cholinergic effects peripherally. These effects include slowing of the heart rate, increased GI secretions (gastric acid) and increased respiratory secretions. Therefore, the drugs are relatively contraindicated in patients with bradycardia, sick sinus syndrome, peptic ulcer disease, and asthma, COPD and recent MI.

Advise patient to discontinue CHE-I therapy in advance of major surgery (CHE-I may potentiate paralytic agents).

In clinical trials, rivastigmine was associated with a high incidence of GI adverse effects. It is important to note that if therapy is interrupted for several days or more, rivastigmine should be initiated at 1.5 mg b.i.d. and retitrated. A change in the rivastigmine 2001 prescribing information was made in response to a report of severe vomiting and esophageal rupture in one patient who was inappropriately given a 4.5 mg dose of rivastigmine, without retitration, following an eight-week treatment cessation.