Galantamine

Adults/elderly, mild to moderately severe dementia of the Alzheimer type; the diagnosis should be confirmed according to current clinical guidelines by an experienced physician and treatment supervised by a physician, only initiated if a caregiver is available to monitor intake. Reassess tolerance and dosing regularly, preferably within three months of starting, then on a regular basis; continue while therapeutic benefit is favourable and treatment is tolerated, and consider discontinuation when a therapeutic effect is no longer present or the patient does not tolerate treatment. In patients not showing an increased response to, or not tolerating, 24 mg/day, a dose reduction back to 16 mg/day should be considered. There is no rebound effect after abrupt discontinuation. Switching from galantamine tablets or oral solution to prolonged-release capsules: give the same total daily dose — take the last tablet/solution dose in the evening and start the prolonged-release capsule once daily the following morning. Moderate hepatic impairment (Child-Pugh 7-9): start with 8 mg every other day, preferably in the morning, for one week, then 8 mg once daily for four weeks; daily doses should not exceed 16 mg. No adjustment for mild hepatic impairment; contraindicated in severe hepatic impairment (Child-Pugh above 9). Dose reductions can be considered in patients taking potent CYP2D6 or CYP3A4 inhibitors. Capsules should be swallowed whole with liquid and must not be chewed or crushed; for swallowing difficulty the capsule may be emptied and the tablet core(s) swallowed whole. Ensure adequate fluid intake during treatment. There is no relevant use of galantamine in the paediatric population. Weight should be monitored during therapy (cholinesterase inhibitors are associated with weight loss). Discontinue at the first appearance of skin rash (serious skin reactions reported).