How to Help Your Patients Find Rivastigmine in Stock: A Provider's Guide

When a patient with Alzheimer's or Parkinson's disease dementia calls your office because their pharmacy is out of rivastigmine, having a clear action protocol saves time, reduces patient and caregiver anxiety, and prevents interruptions in treatment. This guide gives you practical, clinically grounded steps to help your patients navigate pharmacy availability for rivastigmine.

Step 1: Clarify Exactly What Form and Strength Is Needed

The first step is ensuring clarity about the prescription details. Rivastigmine has multiple formulations:

Oral capsules: 1.5 mg, 3 mg, 4.5 mg, 6 mg (generic only — brand Exelon capsule discontinued)

Oral solution: 2 mg/mL (useful for patients who have difficulty swallowing capsules)

Transdermal patches: 4.6 mg/24h (initial dose), 9.5 mg/24h (standard maintenance), 13.3 mg/24h (maximum dose for Alzheimer's); Exelon Patch brand and generic versions exist

A pharmacy may have one strength available but not another. Knowing exactly what the patient is looking for — and whether you have clinical flexibility to adjust — is the foundation for the next steps.

Step 2: Direct Patients (and Caregivers) to medfinder

medfinder is a paid service that contacts pharmacies near the patient to determine which ones can fill a specific prescription. For dementia patients and their caregivers — who often have limited time and significant caregiver burden — making a dozen phone calls is unrealistic. medfinder handles this process and texts the results. Refer your patients or their caregivers to medfinder.com/providers to learn more.

Step 3: Write the Prescription to Enable Substitution

When writing or renewing a rivastigmine prescription, consider these practices that give the patient and pharmacist more flexibility:

Allow generic substitution — any generic manufacturer is acceptable

Write for the patch AND capsule if the patient is willing to use either, pending availability

Include a note with adjacent patch strengths (e.g., "9.5 mg/24h preferred; 13.3 mg/24h acceptable") if the patient is stable and dose flexibility is clinically appropriate

Authorize a 90-day supply to reduce the frequency of pharmacy searches

Step 4: Route Patients to Mail-Order Pharmacy

For patients on stable maintenance doses, mail-order pharmacy is often the most reliable long-term solution. Mail-order pharmacies maintain higher inventory levels for specialty medications and are less affected by local supply variability. Most Medicare Part D and commercial insurance plans include a mail-order option with reduced copays for 90-day supplies.

Common mail-order options include Express Scripts, OptumRx, CVS Caremark, and Humana Pharmacy. Note that patients will need a new prescription written specifically for a 90-day supply, as 30-day prescriptions may not be convertible.

Step 5: Have a Prepared Switching Protocol Ready

If a patient truly cannot access rivastigmine and has missed several doses, having a pre-prepared switching protocol reduces phone tag and triage time. Consider having your team:

Maintain a standing order template for switching to donepezil for Alzheimer's patients

Have retitration instructions ready for patients who have missed >3 days

Use patient portal messaging to push guidance when access issues arise, reducing phone volume

Step 6: Educate Caregivers to Be Proactive

The reality is that most rivastigmine patients have a caregiver managing their medications. Educate caregivers to:

Start looking for refills 10–14 days early, especially for the transdermal patch

Keep a small backup supply when possible

Know the exact strength and form being used (patch vs. capsule, mg/24h)

Contact the prescriber's office early — not when the last dose has been taken

Additional Resources for Prescribers

For a deeper dive into the clinical shortage picture, see our provider shortage guide for rivastigmine. For cost-related access barriers, see our guide to savings programs for rivastigmine patients.