Galantamine
Related Subjects:
|Alzheimer disease (Dementia)
|Dementias
|Donepezil
|Rivastigmine
|Memantine
💊 Galantamine is an acetylcholinesterase (AChE) inhibitor for mild to moderate Alzheimer's disease. Initiate it on the advice of a specialist (old-age psychiatry, geriatrics or neurology) after diagnosis and discussion of realistic benefits. It may temporarily stabilise or modestly improve cognition and function, but it does not halt progression.
📖 About
- NICE NG97: donepezil, galantamine and rivastigmine are options for mild–moderate Alzheimer's disease; choose the drug with the lowest acquisition cost unless another suits the patient better.
- For dementia with Lewy bodies, donepezil or rivastigmine are preferred; galantamine is only an option if those are not tolerated.
- Always check the BNF for up-to-date prescribing information.
⚙️ Mode of Action
- Reversible, competitive AChE inhibitor → ↑ synaptic acetylcholine.
- Also an allosteric modulator of nicotinic receptors (enhances acetylcholine response).
🎯 Indications
- Mild to moderately severe Alzheimer's disease.
- Mixed Alzheimer's/vascular dementia (Alzheimer's component).
💊 Dose (adult)
| Preparation | Start | Titration | Maintenance |
|---|
| Immediate-release (tablets/oral solution) | 4 mg twice daily for 4 weeks | 8 mg twice daily for at least 4 weeks | 8–12 mg twice daily (with food) |
| Modified-release capsules | 8 mg once daily (morning) for 4 weeks | 16 mg once daily for at least 4 weeks | 16–24 mg once daily |
| Moderate hepatic impairment | 4 mg once daily for 1 week | Then 4 mg twice daily (or MR 8 mg on alternate days for 1 week) | Max 8 mg twice daily (MR 16 mg daily) |
- If treatment is interrupted for more than 3 days, restart at the lowest dose and re-titrate.
🧪 Monitoring
- Pulse at baseline and at each review; ECG if there is bradycardia, conduction disease or syncope.
- Weight (anorexia and weight loss are common).
- Review cognition, function and adverse effects at about 3 months, then regularly.
🔄 Interactions
- Rate-slowing drugs (beta-blockers, digoxin, diltiazem, verapamil, amiodarone): additive bradycardia/heart block.
- Antimuscarinics (oxybutynin, TCAs, etc.) oppose its effect - review anticholinergic burden.
- CYP3A4/2D6 inhibitors (ketoconazole, erythromycin, paroxetine, fluoxetine) ↑ levels.
- Suxamethonium: prolonged neuromuscular block - tell the anaesthetist.
- NSAIDs: ↑ GI bleeding risk.
⚠️ Cautions
- Sick sinus syndrome or other supraventricular conduction abnormalities; recent MI, unstable angina, heart failure.
- Asthma or COPD (bronchoconstriction).
- Peptic ulcer disease or risk (↑ gastric acid).
- Seizures; urinary outflow obstruction; recent GI or bladder surgery.
🚫 Contraindications
- Severe hepatic impairment (Child–Pugh >9).
- Severe renal impairment (creatinine clearance <9 mL/min).
💥 Side Effects
- Very common: nausea, vomiting.
- Common: diarrhoea, abdominal pain, anorexia and weight loss, dizziness, headache, fatigue, insomnia, depression, bradycardia, syncope, falls, muscle spasm.
- Uncommon/rare: heart block, seizures, hallucinations, hepatitis, serious skin reactions (SJS, AGEP - stop at first sign of rash).
📚 References
