Galantamine

Indications

Galantamine is used for: Dementia in Alzheimer's disease.

Adult Dose

Alzheimer Disease Initial 4 mg PO q12hr Maintenance Titrate to 8-12 mg PO q12hr; increase by 4 mg q12hr at no less than 4 week intervals Hepatic Impairment Moderate: (Child-Pugh score 7-9): Not to exceed 16 mg/day Severe: Not recommended

Child Dose

Not recommended

Renal Dose

Renal Impairment Moderate: Not to exceed 16 mg/day Severe (CrCl <9 mL/min): Not recommended

Administration

Should be taken with food.

Contra Indications

Hypersensitivity; severe liver or kidney dysfunction; lactation; disorders of galactose metabolism; urinary retention or GI obstruction. Lactation.

Precautions

Mild-moderate hepatic impairment; supraventricular conduction abnormalities; asthma; COPD; pregnancy; peptic ulcers. May increase gastric acid production.

Pregnancy-Lactation

Pregnancy Category: B Lactation: unknown

Interactions

ncreased serum concentrations when used with drugs that inhibit CYP2D6 (e.g. quinidine, fluoxetine, fluvoxamine, and paroxetine) and CYP3A4 (e.g. ketoconazole and ritonavir). Cimetidine may increase the bioavailability of galantamine. Increased risk of gastric ulcer when used with NSAIDs. Potentially Fatal: Amiodarone, ?-blockers, diltiazem or verapamil; NSAIDs; digoxin.

Side Effects

Side effects of Galantamine : >10% Nausea (20-25%), Diarrhea (11-15%), Vomiting (11-15%) 1-10% Abdominal pain, Anorexia, Muscle cramp, Fatigue, Dizziness, Headache, Weight loss, Depression, Insomnia, UTI, Somnolence, Anemia, Syncope, Bradycardia Potentially Fatal: CV effects; convulsion; delirium; rectal haemorrhage; thrombocytopenia.

Mode of Action

Galantamine is a centrally-acting cholinesterase inhibitor, elevating acetylcholine in the cerebral cortex. Glutamine and serotonin levels may also be increase. It has nicotinic receptor agonist properties.