Two medicines, side by side
Rivastigmine vs donepezil
Rivastigmine and donepezil are both labeled for alzheimer's disease. Drugs@FDA records approvals of rivastigmine since 2000 and of donepezil since 1996. Pharmacies paid $0.164 per rivastigmine 1.5 mg capsule and $0.0484 per donepezil HCl 10 mg tablet (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. How each works, in its label's words: Rivastigmine, “Although the precise mechanism of action of rivastigmine is unknown, it is thought to exert its therapeutic effect by enhancing cholinergic function.”; Donepezil, “Current theories on the pathogenesis of the cognitive signs and symptoms of Alzheimer’s disease attribute some of them to a deficiency of cholinergic neurotransmission.”
Check it at the source: the rivastigmine FDA label on DailyMed (effective June 19, 2024); the donepezil FDA label on DailyMed (effective December 30, 2021).
Highlights of the rivastigmine record
Rivastigmine (Exelon) · label of June 19, 2024
Used for
From the label: indicationsRivastigmine tartrate capsules are an acetylcholinesterase inhibitor indicated for treatment of: Mild-to-moderate dementia of the Alzheimer’s type (AD) ( 1.1 ) Mild-to-moderate dementia associated with Parkinson’s disease (PD) ( 1.2 ) 1.1 Alzheimer’s Disease Rivastigmine tartrate capsules are indicated for the treatment of mild-to-moderate dementia of the Alzheimer's type (AD). 1.2 Parkinson’s Disease Dementia Rivastigmine tartrate capsules are indicated for the treatment of mild-to-moderate dementia associated with Parkinson’s disease (PD). […]
On the market
- Earliest approval on file
- April 21, 2000
- Generic labelers
- 18 labelers
- Pharmacy cost
- $0.164 per capsule
Supply and safety
- Shortage
- A presentation being discontinued
- Recalls
- 2
Highlights of the donepezil record
Donepezil (Aricept) · label of December 30, 2021
Used for
From the label: indicationsARICEPT is indicated for the treatment of dementia of the Alzheimer’s type. Efficacy has been demonstrated in patients with mild, moderate, and severe Alzheimer’s disease. ARICEPT is an acetylcholinesterase inhibitor indicated for the treatment of dementia of the Alzheimer’s type. Efficacy has been demonstrated in patients with mild, moderate, and severe Alzheimer’s Disease
On the market
- Earliest approval on file
- November 25, 1996
- Generic labelers
- 31 labelers
- Pharmacy cost
- $0.0484 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 5
Source: FDA drug labels via openFDA (Rivastigmine label of June 19, 2024, Donepezil label of December 30, 2021); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do rivastigmine and donepezil differ on the record?
How each works, in its label's words: Rivastigmine, “Although the precise mechanism of action of rivastigmine is unknown, it is thought to exert its therapeutic effect by enhancing cholinergic function.”; Donepezil, “Current theories on the pathogenesis of the cognitive signs and symptoms of Alzheimer’s disease attribute some of them to a deficiency of cholinergic neurotransmission.”
Both are in FDA's class cholinesterase inhibitors.
Generics: rivastigmine since 2007; donepezil since 2009 (Drugs@FDA).
| Rivastigmine | Donepezil | |
|---|---|---|
| Labeled for | Alzheimer's disease | Alzheimer's disease |
| Pharmacologic class | Cholinesterase Inhibitor | Cholinesterase Inhibitor |
| How it works (label) | Although the precise mechanism of action of rivastigmine is unknown, it is thought to exert its therapeutic effect by enhancing cholinergic function. | Current theories on the pathogenesis of the cognitive signs and symptoms of Alzheimer’s disease attribute some of them to a deficiency of cholinergic neurotransmission. |
| Half-life (label) | The elimination half-life is about 1.5 hours, with most elimination as metabolites via the urine. | n/a |
| Earliest approval on file (Drugs@FDA) | April 21, 2000 | November 25, 1996 |
| First generic approved | October 22, 2007 | December 11, 2009 |
| Generic labelers (NDC) | 18 labelers | 31 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.164 per capsule (Rivastigmine 1.5 mg capsule) | $0.0484 per tablet (Donepezil HCl 10 mg tablet) |
| 12-month price change | -11% | -0.9% |
| Boxed warning | No | No |
| Shortage now | A presentation being discontinued | No current entry |
| Recalls recorded | 2 | 5 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 19,159 | 36,484 |
| DEA schedule | none | none |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What next?
- Alternatives to rivastigmine
- every medicine labeled for the same conditions