Galantamine

Galantamine Brand Name– Razadyne | Reminyl

What is Galantamine

Galantamine is a cholinesterase (ChE) inhibitor. The drug is a natural alkaloid originating from the bulbs of the common snowdrop flower, also known as the daffodil or Galanthus nivalis.

Galantamine is FDA approved for the treatment of mild to moderate dementia of the Alzheimer’s type.

Galantamine is a first-line treatment option for Alzheimer’s disease; although similar to other ChE inhibitors, the drug does not alter the progressive degenerative process of the disease.

Limited data suggest that galantamine may also be beneficial in treating symptoms of vascular dementia and Dementia with Lewy bodies (DLB).

ChE inhibitors, including galantamine, have not shown long-term benefit in delaying or preventing the progression of Mild Cognitive Impairment (MCI) to Alzheimer’s disease.

In addition, there was a significant difference in mortality between patients in the galantamine groups (n = 13) and placebo groups (n = 1) in two controlled trials of 2 years duration in patients with MCI (n = 2,048). About half of the galantamine deaths appeared to result from various vascular causes (myocardial infarction, stroke, and sudden death).

These findings are not consistent with other galantamine studies, and further investigation is warranted to determine the association between galantamine and an increased risk of mortality in MCI patients.

Galantamine has been used in humans for over 30 years as an anticurare agent in anesthesia in countries outside the United States.

Also outside of the U.S., where the drug is known as Nivalin, galantamine has been used off-label for other conditions including glaucoma, muscular dystrophy, myasthenia gravis, and neuritis.

Compared to donepezil and similar to rivastigmine, galantamine requires multiple daily dosages and a slow dosage titration to limit GI side effects.

Galantamine was first approved by the FDA in 2001.

Indications

  1. Alzheimer’s disease
  2. dementia with Lewy bodies
  3. vascular dementia

For the treatment of mild to moderate Alzheimer’s disease

Side Effects

  1. abdominal pain
  2. acute generalized exanthematous pustulosis (AGEP)
  3. anorexia
  4. asthenia
  5. AV block
  6. blurred vision
  7. bradycardia
  8. dehydration
  9. depression
  10. diarrhea
  11. dizziness
  12. drowsiness
  13. dysgeusia
  14. dyspepsia
  15. elevated hepatic enzymes
  16. erythema multiforme
  17. fatigue
  18. flushing
  19. hallucinations
  20. headache
  21. hepatitis
  22. hyperhidrosis
  23. hypertension
  24. hypotension
  25. lethargy
  26. malaise
  27. muscle cramps
  28. myasthenia
  29. nausea
  30. palpitations
  31. paresthesias
  32. seizures
  33. Stevens-Johnson syndrome
  34. syncope
  35. tinnitus
  36. tremor
  37. urinary retention
  38. vomiting
  39. weight loss

Monitoring Parameters

  • neurologic function
  • weight

Contraindications

  • asthma
  • AV block
  • bladder obstruction
  • bradycardia
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • children
  • chronic obstructive pulmonary disease (COPD)
  • dehydration
  • diarrhea
  • driving or operating machinery
  • geriatric
  • GI bleeding
  • hepatic disease
  • hypotension
  • infants
  • mortality
  • peptic ulcer disease
  • pregnancy
  • renal failure
  • renal impairment
  • seizure disorder
  • seizures
  • serious rash
  • sick sinus syndrome
  • surgery
  • syncope
  • urinary tract obstruction
  • vomiting

Interactions

  • Acebutolol
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Diphenhydramine
  • Acrivastine; Pseudoephedrine
  • Amantadine
  • Ambenonium Chloride
  • Amifampridine
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amoxapine
  • Anticholinergics
  • Articaine; Epinephrine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Atenolol
  • Atenolol; Chlorthalidone
  • Atracurium
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Bendroflumethiazide; Nadolol
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benztropine
  • Beta-adrenergic blockers
  • Betaxolol
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Brimonidine; Timolol
  • Brompheniramine
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Bupivacaine
  • Bupivacaine Liposomal
  • Bupivacaine; Lidocaine
  • Carbetapentane; Chlorpheniramine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pyrilamine
  • Carbinoxamine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Carteolol
  • Carvedilol
  • Chlophedianol; Dexbrompheniramine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlorcyclizine
  • Chlordiazepoxide; Clidinium
  • Chloroprocaine
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Cholinergic agonists
  • Cisatracurium
  • Clemastine
  • Clomipramine
  • Clozapine
  • Cocaine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Cyclizine
  • Cyclobenzaprine
  • Cyproheptadine
  • Desipramine
  • Dexchlorpheniramine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Promethazine
  • Dicyclomine
  • Digoxin
  • Dimenhydrinate
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Disopyramide
  • Dorzolamide; Timolol
  • Doxepin
  • Doxylamine
  • Doxylamine; Pyridoxine
  • Esmolol
  • Etomidate
  • Flavoxate
  • Fluoxetine; Olanzapine
  • Fospropofol
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Halogenated Anesthetics
  • Homatropine; Hydrocodone
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydroxyzine
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Imipramine
  • Indacaterol; Glycopyrrolate
  • Ketamine
  • Labetalol
  • Levobetaxolol
  • Levobunolol
  • Levobupivacaine
  • Lidocaine
  • Lidocaine; Prilocaine
  • Maprotiline
  • Meclizine
  • Mepenzolate
  • Meperidine; Promethazine
  • Mepivacaine
  • Mepivacaine; Levonordefrin
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methocarbamol
  • Methscopolamine
  • Metoprolol
  • Mivacurium
  • Nadolol
  • Nebivolol
  • Nebivolol; Valsartan
  • Nonsteroidal antiinflammatory drugs
  • Nortriptyline
  • Olanzapine
  • Orphenadrine
  • Oxybutynin
  • Pancuronium
  • Penbutolol
  • Perphenazine; Amitriptyline
  • Phenylephrine; Promethazine
  • Pindolol
  • Prilocaine
  • Prilocaine; Epinephrine
  • Procaine
  • Promethazine
  • Propantheline
  • Propofol
  • Propranolol
  • Protriptyline
  • Rocuronium
  • Ropivacaine
  • Scopolamine
  • Sedating H1-blockers
  • Solifenacin
  • Sotalol
  • Succinylcholine
  • Tetracaine
  • Thioridazine
  • Timolol
  • Tolterodine
  • Tricyclic antidepressants
  • Trihexyphenidyl
  • Trimipramine
  • Triprolidine
  • Trospium
  • Vecuronium
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