Atenolol and Rivastigmine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 15, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Rivastigmine
Atenolol
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Both of these medicines can slow your heart rate, and together the effect can add up. Rivastigmine (Exelon) is used for memory problems, and one of its known effects is slowing the heart. Atenolol (Tenormin) is a beta-blocker that also slows the heart. When you take them together, your heartbeat could get too slow, which might make you feel dizzy, lightheaded, or even faint.
The good news is that your care team knows how to handle this. They may keep a closer eye on your heart rate and adjust things as needed. Please don't stop or change either medicine on your own. Just let your pharmacist or doctor know if you feel dizzy or faint.
Effect: Additive bradycardia with risk of syncope when rivastigmine is combined with atenolol.
Mechanism: Pharmacodynamic (not PK). Rivastigmine, a cholinesterase inhibitor, increases vagal/cholinergic tone and can produce bradycardia; atenolol, a cardioselective beta-blocker, slows heart rate via beta-1 blockade. Effects are additive on the SA node. Neither agent's clearance drives this interaction.
- Direction: Increased bradycardic effect.
- Onset: Unspecified.
- Evidence: Theoretical; mechanism plausible but not well substantiated.
- Management: Combination generally not recommended; if co-prescribed, monitor heart rate and for symptoms of bradycardia/syncope. Doses may need individualization.
What happens
Additive bradycardic effects
Interaction Deep Dive
Because their bradycardic effects are additive and can lead to syncope, taking rivastigmine together with beta-blockers, particularly cardioselective ones, is advised against1.
Why it happens (mechanism)
Unknown
How to manage this interaction
The main concern is that both drugs slow your heart rate, so together they may slow it too much. Here is what typically happens and what you can do:
- Your care team may check your heart rate more closely and watch for symptoms like dizziness or fainting.
- They may adjust and individualize your doses, or in some cases choose a different medicine, since this combination is often not recommended.
- Keep taking both exactly as prescribed unless your doctor tells you otherwise.
Tell your pharmacist or prescriber if you feel dizzy, lightheaded, faint, or notice a very slow pulse.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Atenolol and Rivastigmine together?
Rivastigmine and atenolol both slow the heart, so taken together they can cause a dangerously slow heartbeat and fainting; this combination is often avoided, so ask your care team to monitor you and report any dizziness or fainting. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atenolol and Rivastigmine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Atenolol and Rivastigmine interaction managed?
The main concern is that both drugs slow your heart rate, so together they may slow it too much. Here is what typically happens and what you can do: Your care team may check your heart rate more closely and watch for symptoms like dizziness or fainting. They may adjust and individualize your doses, or in some cases choose a different medicine, since this combination is often not recommended. Keep… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Atenolol or Rivastigmine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: EXELON(R) PATCH transdermal system, rivastigmine transdermal system. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2015. DailyMed
Keep reading about Rivastigmine
Keep reading about Atenolol
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist