Administration: Exelon hard capsules should be administered twice a day, with morning and evening meals.
Initial dose: 1.5 mg twice a day. Patients known to be particularly sensitive to the effects of cholinergic drugs should be started at a dose of 1 mg twice a day.
Dose titration: The starting dose is 1.5 mg twice a day. If this dose is well tolerated after a minimum of two weeks of treatment, the dose may be increased to 3 mg twice a day. Subsequent increases to 4.5 mg and then 6 mg twice a day should also be based on good tolerability of the current dose and may be considered after a minimum of two weeks' treatment at that dose level.
If adverse effects (e.g. nausea, vomiting, abdominal pain or loss of appetite) or weight decrease are observed during treatment, these may respond to omitting one or more doses. If adverse effects persist, the daily dose should be reduced to the previous well-tolerated dose.
Maintenance dose: 1.5 mg to 6 mg twice a day; to achieve maximum therapeutic benefit patients should be maintained on their highest well-tolerated dose.
Recommended maximum daily dose: 6 mg twice a day.
Re-initiation of therapy: The incidence and severity of adverse events are generally increased with higher doses.
If treatment is interrupted for longer than three days, treatment should be re-initiated with the lowest daily dose and titrated as described previously.
Special Population: Paediatric patients: Children and adolescents (age below 18 years): The use of Exelon in children has not been studied and is therefore not recommended.
Renal impairment or hepatic impairment: No dose adjustment is necessary in patients with renal or hepatic impairment. However, due to increased exposure in moderate renal and mild to moderate hepatic impairment, dosing recommendations to titrate according to individual tolerability should be closely followed as patients with clinically significant renal or hepatic impairment might experience more dose dependent adverse reactions. Patients with severe hepatic impairment have not been studied, however, Exelon capsules may be used in this patient population provided close monitoring is exercised (see Pharmacology: Pharmacokinetics: Special Population under Actions and Precautions).