Galantamine

How it works

It reversibly inhibits acetylcholinesterase and additionally acts as an allosteric modulator of nicotinic acetylcholine receptors, enhancing cholinergic neurotransmission.

Prescribing in practice

• Serious skin reactions including Stevens-Johnson syndrome have been reported, and treatment should be stopped at the first sign of a rash.
• Use with caution in cardiac conduction disorders, peptic ulcer disease and asthma or COPD because of cholinergic effects, and reduce exposure in hepatic or renal impairment.
• Avoid in severe hepatic or renal impairment and titrate slowly to limit gastrointestinal intolerance.

Monitoring

Monitor weight, heart rate, cognitive and functional response, and review for gastrointestinal and cardiac adverse effects.

Counselling the patient

• Take with food to reduce nausea, and report significant weight loss.
• Stop the medicine and seek advice immediately if a skin rash develops.
• Report fainting, a slow pulse or persistent vomiting.

Evidence & guidelines

NICE recommends acetylcholinesterase inhibitors including galantamine as options for managing mild to moderate Alzheimer's disease.