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If you are still concerned about using estrogen, however, you do have other options. You might start with water-based vaginal moisturizers like Replens, which studies find can be more effective for symptoms of vaginal atrophy than even estrogen cream. Vitamin E, in oral doses of between 100 and 600 IU, or administered directly to the vagina, can also improve vaginal dryness. Another option is a topical oil made from botanical ingredients, called Zestra Feminine Arousal Fluid, which one published study found significantly improved women's sexual experience (including orgasms) compared to a placebo topical oil.
Overdosage with cholinesterase inhibitors can result in cholinergic crisis characterized by severe nausea, vomiting, salivation, sweating, bradycardia , hypotension , respiratory depression, and convulsions. Increasing muscle weakness is a possibility and may result in death if respiratory muscles are involved. Atypical responses in blood pressure and heart rate have been reported with other drugs that increase cholinergic activity when coadministered with quaternary anticholinergics such as glycopyrrolate. Additional symptoms associated with rivastigmine overdose are diarrhea, abdominal pain, dizziness, tremor , headache, somnolence , confusional state, hyperhidrosis , hypertension , hallucinations and malaise . Due to the short plasma elimination half-life of rivastigmine after patch administration, dialysis ( hemodialysis , peritoneal dialysis , or hemofiltration) would not be clinically indicated in the event of an overdose.