Drug Action
Galantamine is a reversible inhibitor of acetylcholinesterase and it also has nicotinic receptor agonist properties.
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Drug reference
Galantamine is a reversible inhibitor of acetylcholinesterase and it also has nicotinic receptor agonist properties.
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Mild to moderately severe dementia in Alzheimer’s disease ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: Initially 4 mg twice daily for 4 weeks, increased to 8 mg twice daily for at least 4 weeks; maintenance 8–12 mg twice daily ▶BY MOUTH USING MODIFIED-RELEASE CAPSULES ▶Adult: Initially 8 mg once daily for 4 weeks, increased to 16 mg once daily for at least 4 weeks; maintenance 16–24 mg daily
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Avoid in gastro-intestinal obstruction. avoid in urinary outflow obstruction. avoid whilst recovering from bladder surgery. avoid whilst recovering from gastro- intestinal surgery. cardiac disease. chronic obstructive pulmonary disease. congestive heart failure. electrolyte disturbances. history of seizures. history of severe asthma . pulmonary infection. sick sinus syndrome. supraventricular conduction abnormalities. susceptibility to peptic ulcers. unstable angina CAUTIONS, FURTHER INFORMATION ▶Elderly For acetylcholinesterase inhibitors, prescription potentially inappropriate (STOPP criteria) in patients with a known history of persistent bradycardia (heart rate less than 60 beats per minute), heart block, recurrent unexplained syncope or concurrent treatment with drugs that reduce heart rate (risk of cardiac conduction failure, syncope and injury). See also Prescribing in the elderly p. 33.
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NICE decisions ▶Donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease (updated June 2018) NICE TA217 The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine, and rivastigmine as monotherapies are recommended as options for managing mild to moderate Alzheimer’s disease under all of the conditions specified below and in recommendation 1.5.5 of the NICE guideline on dementia. If prescribing an AChE inhibitor (donepezil, galantamine, or rivastigmine), treatment should normally be started with the drug with the lowest acquisition cost (taking into account required daily dose and the price per dose once shared care has started). However, an alternative AChE inhibitor could be prescribed if it is considered appropriate when taking into account adverse event profile, expectations about adherence, medical comorbidity, possibility of drug interactions and dosing profiles. Healthcare professionals should not rely solely on assessment scales to determine the severity of Alzheimer’s disease when the patient has learning or other disabilities, or other communication difficulties. www.nice.org.uk/guidance/ta217
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→Appendix 1: anticholinesterases, centrally acting
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▶Common or very common Appetite decreased. arrhythmias . asthenia. depression. diarrhoea. dizziness. drowsiness. fall. gastrointestinal discomfort. hallucinations. headache. hypertension. malaise. muscle spasms. nausea . skin reactions. syncope. tremor. vomiting. weight decreased ▶Uncommon Atrioventricular block. dehydration. flushing. hyperhidrosis. hypersomnia. hypotension. muscle weakness. palpitations. paraesthesia. seizure. taste altered. tinnitus. vision blurred ▶Rare or very rare Hepatitis. severe cutaneous adverse reactions (SCARs) SIDE-EFFECTS, FURTHER INFORMATION Manufacturer advises increasing dose according to response and tolerability. Serious skin reactions Serious skin reactions (including Stevens-Johnson syndrome and acute Nervous system generalized exanthematous pustulosis) have been reported—manufacturer advises discontinue at the first appearance of skin rash.
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Use with caution—toxicity in animal studies.
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Avoid—no information available.
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Manufacturer advises caution in moderate impairment (risk of increased plasma concentrations); avoid in severe impairment (no information available). Dose adjustments Manufacturer advises for immediate- release preparations in moderate impairment, initially 4 mg once daily (preferably in the morning) for at least 7 days, then 4 mg twice daily for at least 4 weeks; maximum 8 mg twice daily. Manufacturer advises for modified-release preparations in moderate impairment, initially 8 mg on alternate days (preferably in the morning) for 7 days, then 8 mg once daily for 4 weeks; maximum 16 mg daily.
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Avoid if eGFR less than 9 mL/minute/1.73 m2.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: tablet Oral solution CAUTIONARY AND ADVISORY LABELS 3, 21 ▶Galantamine (Non-proprietary) Galantamine (as Galantamine hydrobromide) 4 mg per 1 ml Galantamine 20mg/5ml oral solution sugar free sugar-free | 100 ml P £120.00 DT = £120.00 ▶Galzemic (Creo Pharma Ltd) Galantamine (as Galantamine hydrobromide) 4 mg per 1 ml Galzemic 4mg/ml oral solution sugar-free | 100 ml P £90.00 DT = £120.00 ▶Reminyl (Shire Pharmaceuticals Ltd) Galantamine (as Galantamine hydrobromide) 4 mg per 1 ml Reminyl 4mg/ml oral solution sugar-free | 100 ml P £120.00 DT = £120.00 Modified-release capsule CAUTIONARY AND ADVISORY LABELS 3, 21, 25 ▶Acumor XL (Mylan) Nervous system Galantamine (as Galantamine hydrobromide) 8 mg Acumor XL 8mg capsules | 28 capsule P £49.26 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Acumor XL 16mg capsules | 28 capsule P £61.65 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Acumor XL 24mg capsules | 28 capsule P £75.81 DT = £79.80 ▶Consion XL (Dr Reddy’s Laboratories (UK) Ltd) Galantamine (as Galantamine hydrobromide) 8 mg Consion XL 8mg capsules | 28 capsule P £25.94 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Consion XL 16mg capsules | 28 capsule P £32.45 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Consion XL 24mg capsules | 28 capsule P £39.90 DT = £79.80 ▶Elmino (Zentiva) Galantamine (as Galantamine hydrobromide) 8 mg Elmino XL 8mg capsules | 28 capsule P £51.88 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Elmino XL 16mg capsules | 28 capsule P £64.90 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Elmino XL 24mg capsules | 28 capsule P £79.80 DT = £79.80 ▶Gaalin (Milpharm Ltd) Galantamine (as Galantamine hydrobromide) 8 mg Gaalin 8mg modified-release capsules | 28 capsule P £51.88 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Gaalin 16mg modified-release capsules | 28 capsule P £64.90 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Gaalin 24mg modified-release capsules | 28 capsule P £79.80 DT = £79.80 ▶Galantex XL (Creo Pharma Ltd) Galantamine (as Galantamine hydrobromide) 8 mg Galzemic XL 8mg capsules | 28 capsule P £19.05 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Galzemic XL 16mg capsules | 28 capsule P £23.84 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Galzemic XL 24mg capsules | 28 capsule P £29.32 DT = £79.80 ▶Galsya XL (Consilient Health Ltd) Galantamine (as Galantamine hydrobromide) 8 mg Galsya XL 8mg capsules | 28 capsule P £44.09 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Galsya XL 16mg capsules | 28 capsule P £55.16 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Galsya XL 24mg capsules | 28 capsule P £67.83 DT = £79.80 ▶Gatalin XL (Aspire Pharma Ltd) Galantamine (as Galantamine hydrobromide) 8 mg Gatalin XL 8mg capsules | 28 capsule P £25.94 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Gatalin XL 16mg capsules | 28 capsule P £32.45 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Gatalin XL 24mg capsules | 28 capsule P £39.90 DT = £79.80 ▶Gazylan XL (Teva UK Ltd) Galantamine (as Galantamine hydrobromide) 8 mg Gazylan XL 8mg capsules | 28 capsule P £19.04 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Gazylan XL 16mg capsules | 28 capsule P £23.83 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Gazylan XL 24mg capsules | 28 capsule P £29.31 DT = £79.80 ▶Lotprosin XL (Accord Healthcare Ltd) Galantamine (as Galantamine hydrobromide) 8 mg Lotprosin XL 8mg capsules | 28 capsule P £51.88 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Lotprosin XL 16mg capsules | 28 capsule P £64.90 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Lotprosin XL 24mg capsules | 28 capsule P £79.80 DT = £79.80 ▶Luventa XL (Fontus Health Ltd) Galantamine (as Galantamine hydrobromide) 8 mg Luventa XL 8mg capsules | 28 capsule P £25.42 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Luventa XL 16mg capsules | 28 capsule P £31.80 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Luventa XL 24mg capsules | 28 capsule P £39.10 DT = £79.80 ▶Reminyl XL (Shire Pharmaceuticals Ltd) Galantamine (as Galantamine hydrobromide) 8 mg Reminyl XL 8mg capsules | 28 capsule P £51.88 DT = £51.88 Galantamine (as Galantamine hydrobromide) 16 mg Reminyl XL 16mg capsules | 28 capsule P £64.90 DT = £64.90 Galantamine (as Galantamine hydrobromide) 24 mg Reminyl XL 24mg capsules | 28 capsule P £79.80 DT = £79.80 Tablet CAUTIONARY AND ADVISORY LABELS 3, 21 ▶Galantamine (Non-proprietary) Galantamine (as Galantamine hydrobromide) 8 mg Galantamine 8mg tablets | 56 tablet P £61.27–£64.90 DT = £61.27 Galantamine (as Galantamine hydrobromide) 12 mg Galantamine 12mg tablets | 56 tablet P £79.80 DT = £74.10
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Manufacturer recommends that patients are warned of the signs of serious skin reactions; they should be advised to stop taking galantamine immediately and seek medical advice if symptoms occur.
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Initially 4 mg twice daily for 4 weeks, increased
First-line fragment. Read the complete Indications and Dose section above.
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Initially 8 mg once daily for 4 weeks, increased
First-line fragment. Read the complete Indications and Dose section above.
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