Galantamine

Class
Anti-dementia agents
Subclass
Acetylcholinesterase inhibitors
Substance name
Galantamine hydrobromide
Brand names
Razadyne®
Common formulations
Film-coated tablet, Solution
See also
Galantamine ER (Razadyne ER®)
Dosage and administration
Adults patients
Alzheimer's disease • Mild-to-moderate
•
Start at: 4 mg PO BID for at least 4 weeks
•
Maintenance: 8-12 mg PO BID
•
Maximum: 24 mg per day
Taken with morning and evening meals. Titrate at 4-week intervals based on response and tolerability.
Dementia in patients with Parkinson's disease • Off-label
•
Start at: 4 mg PO BID for 4 weeks
•
Maintenance: 8-12 mg PO BID
Titrate at 4-week intervals.
Dementia with Lewy bodies • Off-label
•
Start at: 4 mg PO BID for 4 weeks
•
Maintenance: 8-12 mg PO BID
Titrate at 4-week intervals.
Vascular cognitive impairment • Off-label
•
Start at: 4 mg PO BID for 4 weeks
•
Maintenance: 8-12 mg PO BID
Titrate at 4-week intervals.
Indications for use
Labeled indications
Adults
•
Treatment of Alzheimer's disease (mild-to-moderate)
Off-label indications
Adults
•
Treatment of dementia in patients with Parkinson's disease
•
Treatment of dementia with Lewy bodies
•
Treatment of vascular cognitive impairment
Safety risks
Contraindications
Hypersensitivity to galantamine or its components
Warnings and precautions
Bladder outflow obstruction
•
Maintain a high level of suspicion, as cholinomimetics can cause bladder outflow obstruction.
Bradycardia, AV block
•
Maintain a high level of suspicion, as galantamine has vagotonic effects on the sinoatrial and atrioventricular nodes, leading to bradycardia and AV block.
Bronchospasm
•
Use caution in patients with asthma or COPD.
Cholinergic crisis
•
Use caution in patients taking other cholinesterase inhibitors or cholinomimetics.
Exacerbation of skeletal muscle relaxation
•
Use caution in patients receiving succinylcholine-type and similar neuromuscular blocking agents during anesthesia.
Gastrointestinal adverse events
•
Maintain a high level of suspicion, as galantamine is a cholinomimetic and can increase gastric acid secretion and cause nausea, vomiting, diarrhea, loss of appetite, and weight loss. Monitor closely for symptoms of active or occult gastrointestinal bleeding, especially in patients with an increased risk for developing ulcers (history of peptic ulcer disease or concomitant use of NSAIDs).
Seizure
•
Maintain a high level of suspicion, as cholinomimetics can trigger seizures. Recognize that seizures can also be a manifestation of Alzheimer's disease.
Specific populations
Renal impairment
CrCl ≥ 60 mL/min
•
Use acceptable. No dose adjustment required.
CrCl 9-59 mL/min
•
Maximal dose of 16 mg per day.
CrCl < 9 mL/min
•
Do not use.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
Do not use.
Peritoneal dialysis
•
Do not use.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
Maximal dose of 16 mg per day. Titrate with caution.
Child-Pugh C (severe)
•
Do not use.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B1
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Nausea, vomiting
Common 1-10%
•
Bradycardia, lethargy, abdominal discomfort, abdominal pain, asthenia, depression, diarrhea, dizziness, dyspepsia, falls, fatigue, headache, loss of appetite, malaise, muscle spasms, somnolence, syncope, weight loss, tremor
Uncommon < 1%
•
Dehydration, dysgeusia, hypersomnia, blurred vision, paresthesia, AV block, palpitations, skin flushing, hypotension, belching, sweating, muscle weakness
Unknown frequency
•
Hepatitis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, hallucinations, seizure, extrapyramidal signs, tinnitus, ↑ liver enzymes, erythema multiforme
Interactions
Drug(s)
Check Interactions
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