Acetylcholinesterase Inhibitor Pregnancy: C

Galantamine

Brand names: Reminyl, Reminyl XL

Adult dose

Dose: 8 mg once daily (XL) or 4 mg twice daily (IR) for 4 weeks; then 16 mg/day; max 24 mg/day

Route: oral

Frequency: once daily (XL) or twice daily (IR)

Max: 24 mg/day

Also nicotinic receptor modulator (unique among AChEIs); take with meals; titrate slowly; IR twice-daily adherence challenging in dementia — XL preferred

Paediatric dose

Route:

Not licensed in children

Dose adjustments

Renal

Max 16 mg/day if eGFR 9–40 ml/min; avoid if eGFR <9 ml/min

Hepatic

Max 16 mg/day in moderate hepatic impairment; avoid in severe

Clinical pearls

Dual mechanism: AChE inhibitor + nicotinic receptor allosteric potentiator
NICE TA217: licensed for mild-moderate Alzheimer's — choice between donepezil/galantamine/rivastigmine based on patient factors, adherence, and tolerability
Discontinued galantamine: gradual decline expected — family counselling important on what to expect

Contraindications

Severe hepatic impairment
Severe renal impairment (eGFR <9 ml/min)
Urinary retention
Bradycardia/AV block

Side effects

Nausea/vomiting (most common — reduce by taking with food)
Diarrhoea
Anorexia
Weight loss
Bradycardia
Syncope

Interactions

Anticholinergics (reduced effect)
Amantadine (reduced effect)
SSRIs (increased nausea)
Bradycardia-causing drugs

Monitoring

MMSE/MOCA scores (6-monthly)
Weight
Cardiac monitoring if bradycardia risk
ADL assessment

Reference: BNFc; BNF 86; NICE TA217. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways