• See Also
  1. Acetylcholinesterase Inhibitor
  2. Dementia
  3. Dementia Management
  4. Rivastigmine (Exelon)
  5. Donepezil (Aricept)
  • Indication
  1. Alzheimer's Disease related Dementia
  • Mechanism
  1. Acetylcholinesterase Inhibitor
  2. Acts also at Nicotinic Receptors
  3. Derived from Daffodil bulbs
  • Pharmacokinetics
  1. Half-Life: 7 hours in elderly patients
  2. Metabolized by liver enzymes: CYP2D6 and CYP3A4
  • Dosing
  1. May require concurrent Antiemetic use
  2. Immediate Release
    1. Start: 4 mg orally twice daily with breakfast and dinner for 4 weeks
    2. Maintenance: 8 mg orally twice daily for at least 4 weeks
    3. Consider increase to 12 mg orally twice daily if indicated
  3. Extended Release
    1. Start: 8 mg orally daily for 4 weeks
    2. Maintenance: 16 mg orally daily for at least 4 weeks
    3. Consider increase to 24 mg orally daily if indicated
  4. Renal Dosing
    1. GFR 9 to 59 ml/min: Maximum dose 16 mg/day
    2. GFR <9 ml/min: Avoid Galantamine
  • Adverse Effects
  1. See Acetylcholinesterase Inhibitor
  2. Cardiovascular
    1. Syncope
    2. Atrioventricular Block
    3. Bradycardia
  3. Gastrointestinal
    1. Diarrhea
    2. Nausea or Vomiting
    3. Decreased appetite and Weight loss
  4. Neuropsychiatric
    1. Headache
    2. Myalgias
    3. Dizziness and Fall Risk
    4. Vivid dreams
  • Efficacy
  1. Moderately preserved cognitive function for >6 months
  2. References
    1. Raskind (2000) Neurology 54:2261 [PubMed]
    2. Tariot (2000) Neurology 54:2269 [PubMed]
  • Resources
  1. Galantamine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e80ec152-3616-4a13-9266-715550a8c398
  • References
  1. (2001) Med Lett Drugs Ther 43(1107):53-4 [PubMed]
  2. Epperly (2017) Am Fam Physician 95(12): 771-8 [PubMed]