Compare Exelon (Rivastigmine) with Other Alzheimer's and Dementia Medications

When someone you love is diagnosed with Alzheimer’s or another form of dementia, the search for the right medication can feel overwhelming. Exelon, the brand name for rivastigmine, is one of the most commonly prescribed drugs for mild to moderate Alzheimer’s and Parkinson’s disease dementia. But it’s not the only option. Many people wonder: Exelon vs. donepezil? Exelon vs. galantamine? Is one better? Safer? More effective? The truth is, there’s no single best drug - it depends on the person, their symptoms, and how their body reacts.

What is Exelon (Rivastigmine) and How Does It Work?

Exelon is a cholinesterase inhibitor. That means it slows down the breakdown of acetylcholine, a brain chemical that’s crucial for memory, thinking, and learning. In Alzheimer’s, the brain loses cells that make acetylcholine. By keeping more of it active, Exelon helps improve communication between brain cells - at least temporarily.

Exelon comes in three forms: capsules, oral solution, and a skin patch. The patch is popular because it delivers the drug steadily through the skin, reducing stomach upset that some people get with pills. It’s approved for Alzheimer’s disease and dementia linked to Parkinson’s disease. It doesn’t cure dementia, but for many, it can slow down the worsening of symptoms for 6 to 12 months - sometimes longer.

Common Alternatives to Exelon

There are two other cholinesterase inhibitors approved in the U.S. and Australia for Alzheimer’s: donepezil (Aricept) and galantamine (Razadyne). There’s also memantine (Namenda), which works differently and is often used alongside cholinesterase inhibitors in moderate to severe cases.

Let’s break down how Exelon compares to the others.

Exelon vs. Donepezil (Aricept)

Donepezil is the most widely prescribed Alzheimer’s drug in the world. It’s taken once a day as a pill, usually at night. It’s simple, which makes it easier for caregivers to manage.

Exelon, on the other hand, is taken twice daily as a pill or applied as a patch once a day. The patch version avoids the need to remember a second daily dose - a big plus for people with memory issues.

Studies show both drugs offer similar levels of cognitive improvement. But side effects differ. Donepezil is more likely to cause insomnia or vivid dreams. Exelon, especially the pill form, causes more nausea, vomiting, and loss of appetite. The patch reduces these stomach issues by about 40%, according to clinical data from the Alzheimer’s Association.

If someone has a sensitive stomach or struggles with daily pill routines, Exelon patch might be the better pick. If sleep problems are already an issue, donepezil could make them worse.

Exelon vs. Galantamine (Razadyne)

Galantamine works a bit differently than Exelon. It doesn’t just block the enzyme that breaks down acetylcholine - it also boosts how the brain responds to it. This dual action might offer slightly better results in some people, especially in early-stage Alzheimer’s.

Galantamine is taken twice a day as a tablet or extended-release capsule. Like Exelon, it can cause nausea and vomiting. But it also has a higher chance of causing dizziness and slow heart rate, which can be risky for older adults with heart conditions.

Exelon has a slight edge in treating dementia linked to Parkinson’s disease. Galantamine isn’t approved for that use. If Parkinson’s dementia is the main concern, Exelon is often the first choice.

For people who tolerate it well, galantamine can feel more “noticeable” in terms of improved focus or conversation skills. But the side effects can be too much for many.

Exelon vs. Memantine (Namenda)

Memantine doesn’t touch acetylcholine. Instead, it blocks excess glutamate, a brain chemical that can become toxic in advanced Alzheimer’s. It’s used for moderate to severe stages, often in combination with a cholinesterase inhibitor like Exelon.

Memantine is usually taken once or twice a day and has fewer side effects than the others. Common ones include dizziness, headache, and constipation - much milder than stomach upset or heart rhythm changes.

Exelon is not meant for late-stage dementia. If someone is in the middle or late stage, memantine might be added to Exelon - not swapped out. Many doctors start with Exelon or donepezil early, then add memantine as the disease progresses.

Which One Is Right for You?

There’s no universal winner. Here’s how to think about it:

• Choose Exelon (patch) if nausea from pills is a problem, or if the person has Parkinson’s dementia.
• Choose donepezil if simplicity matters most - one pill a day, no patch changes, and no stomach issues.
• Choose galantamine if the person is in early Alzheimer’s and can handle side effects, and Parkinson’s isn’t involved.
• Add memantine if symptoms are getting worse despite an existing cholinesterase inhibitor.

Doctors often start low and go slow. A common approach is to begin with the lowest dose of Exelon patch (4.6 mg/24 hours) and increase it every 4 weeks if tolerated. Same with donepezil - starting at 5 mg, then going to 10 mg after a month.

It can take 8 to 12 weeks to see any real change. Don’t give up too soon. But if side effects like severe vomiting, fainting, or weight loss happen, talk to your doctor right away.

Real-World Experience: What Patients and Caregivers Say

In support groups across Adelaide and Sydney, people share similar stories. One caregiver said her husband switched from donepezil to Exelon patch because he kept forgetting to take his pill. The patch stuck to his arm - no reminders needed. His nausea improved, and he started recognizing family photos again after three months.

Another person tried galantamine but had to stop after two weeks because of dizziness and falls. They switched to Exelon and had no issues.

But not everyone responds. About 30% of people don’t notice any benefit from any of these drugs. That doesn’t mean they’re failing - it just means the disease is progressing differently.

What About Newer Drugs?

Since 2021, new drugs like lecanemab (Leqembi) and donanemab have been approved in the U.S. for early Alzheimer’s. These are IV infusions that target amyloid plaques in the brain. They’re not replacements for Exelon or donepezil - they’re used alongside them.

These newer drugs are expensive, require frequent brain scans, and carry risks like brain swelling or bleeding. They’re not yet widely available in Australia, and Medicare doesn’t fully cover them. For now, Exelon, donepezil, and galantamine remain the backbone of treatment.

Side Effects and Safety

All cholinesterase inhibitors carry similar risks:

• Stomach upset (nausea, vomiting, diarrhea)
• Loss of appetite and weight loss
• Muscle cramps or twitching
• Slow heart rate (bradycardia)
• Fainting or dizziness

People with heart conditions, especially those on beta-blockers or with pacemakers, need careful monitoring. Exelon can lower heart rate more than donepezil in some cases.

The patch version of Exelon is generally safer for the stomach but can cause skin irritation. Rotate the application site every day to avoid rashes.

Cost and Accessibility in Australia

All three cholinesterase inhibitors - Exelon, donepezil, and galantamine - are listed on the Pharmaceutical Benefits Scheme (PBS). That means they’re heavily subsidized. A 30-day supply of Exelon patch costs about $7.30 for concession card holders, and around $30 for others. Donepezil is slightly cheaper at $6.80 for concession holders.

Generic versions of all three are available. Many doctors prescribe the generic rivastigmine instead of the brand Exelon - it’s the same drug, just cheaper.

When to Consider Stopping

There’s no hard rule, but many doctors reconsider these drugs when:

• Side effects are worse than the symptoms
• The person can’t swallow pills or tolerate the patch
• There’s no change after 6 months
• The person enters late-stage dementia and the drug no longer helps

Stopping suddenly can cause a sudden drop in function. Always taper off slowly under medical supervision.

Final Thoughts

Exelon isn’t the best Alzheimer’s drug for everyone - but it’s often the most practical. The patch form makes it easier to use than pills, and it’s uniquely effective for Parkinson’s dementia. Donepezil wins for simplicity. Galantamine might help early-stage cases with fewer side effects. Memantine is the go-to for later stages.

The key is starting low, watching closely, and giving each option a fair chance. No drug stops dementia. But the right one can buy time - time for meaningful conversations, quiet walks, and moments of connection that matter most.

Next Steps for Caregivers

If you’re deciding between Exelon and other drugs, start with these steps:

1. Ask your doctor to explain why they’re recommending one drug over another - is it because of Parkinson’s, stomach issues, or heart concerns?
2. Request a trial of the lowest dose for at least 8 weeks before judging effectiveness.
3. Keep a simple journal: note changes in memory, mood, sleep, appetite, and side effects.
4. Check if generic rivastigmine is available - it’s the same as Exelon but cheaper.
5. Connect with local dementia support groups. Real stories from others can help you feel less alone.

There’s no perfect drug. But the right one - matched to the person’s needs - can make a real difference in quality of life. Take your time. Listen to your doctor. And don’t give up on finding what works.