Galantamine

Aka: Galantamine, Reminyl, Razadyne, Benzgalantamine, Zunveyl

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II. Indications

  1. Alzheimer's Disease related Dementia

III. Contraindications

  1. Severe hepatic dysfunction (Child-Pugh >9)
  2. GFR <9 ml/min

IV. Mechanism

  1. Competitive and Reversible Acetylcholinesterase Inhibitor
  2. Acts also at Nicotinic Receptors
  3. Derived from Daffodil bulbs

V. Pharmacokinetics

  1. Half-Life: 7 hours in elderly patients
  2. Metabolized by liver enzymes: CYP2D6 and CYP3A4

VI. Medications

  1. Galantamine
    1. Tabs: 4, 8, 12 mg
    2. XR caps: 8, 16, 24 mg
    3. Oral Solution: 4 mg/ml
  2. Benzgalantamine (Zunveyl)
    1. Delayed Release Tablets: 5 mg, 10 mg, 15 mg
    2. New Galantamine prodrug due for release in 2025
    3. Twice daily delayed release agent with fewer gastrointestinal adverse effects, but at $800/month
      1. Contrast with extended release Galantamine ($30/month)
    4. Most of efficacy and safety data is extrapolated from Galantamine data
    5. (2025) Presc Lett 32(7): 41

VII. Dosing: Galantamine

  1. May require concurrent Antiemetic use
  2. Immediate Release
    1. Start: 4 mg orally twice daily with breakfast and dinner for 4 weeks
    2. Maintenance: 8 mg orally twice daily for at least 4 weeks
    3. Consider increase to 12 mg orally twice daily if indicated
  3. Extended Release
    1. Start: 8 mg orally daily for 4 weeks
    2. Maintenance: 16 mg orally daily for at least 4 weeks
    3. Consider increase to 24 mg orally daily if indicated
  4. Renal Dosing
    1. GFR 9 to 59 ml/min: Maximum dose 16 mg/day
    2. GFR <9 ml/min: Avoid Galantamine

VIII. Dosing: Benzgalantamine (Zunveyl)

  1. Start: 5 mg orally twice daily swallowed whole without crushing, chewing or splitting
  2. May be taken with or without food
  3. Increase as needed to 10 mg orally twice daily after 4 weeks
  4. Maximum dose
    1. Normal renal and hepatic function: 15 mg orally twice daily
    2. Moderate liver disease (Child-Pugh 7-9) or GFR 10-60 ml/min: 10 mg orally twice daily
    3. GFR <9 ml/min: Avoid Benzgalantamine

IX. Adverse Effects

  1. See Acetylcholinesterase Inhibitor
  2. Cardiovascular
    1. Syncope
    2. Atrioventricular Block
    3. Bradycardia
  3. Gastrointestinal
    1. Diarrhea
    2. Nausea (21%) or Vomiting (11%)
    3. Decreased appetite and Weight loss
    4. Increased gastric acid secretion (may increase risk of Peptic Ulcer Disease)
  4. Genitourinary
    1. Urinary Outflow Obstruction
  5. Neuropsychiatric
    1. Headache (7%)
    2. Myalgias
    3. Dizziness (8%) and Fall Risk
    4. Vivid dreams
  6. Serious skin reactions (<1% of patients)
    1. Stevens Johnson Syndrome
    2. Acute Generalized Exanthematous Pustulosis

X. Safety

  1. Monitor renal and hepatic function at baseline and with clinical change

XI. Efficacy

  1. Moderately preserved cognitive function for >6 months
  2. References
    1. Raskind (2000) Neurology 54:2261 [PubMed]
    2. Tariot (2000) Neurology 54:2269 [PubMed]

XII. Resources

  1. Galantamine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e80ec152-3616-4a13-9266-715550a8c398
  2. Benzgalantamine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=af47bf67-1f07-4650-8064-24c38afc4656

XIII. References

  1. Johnston (2025) Am Fam Physician
  2. (2001) Med Lett Drugs Ther 43(1107):53-4 [PubMed]
  3. Epperly (2017) Am Fam Physician 95(12): 771-8 [PubMed]

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Cost: Medications

galantamine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
GALANTAMINE ER 16 MG CAPSULE Generic $1.66 each
GALANTAMINE ER 24 MG CAPSULE Generic $1.17 each
GALANTAMINE ER 8 MG CAPSULE Generic $1.11 each
GALANTAMINE HBR 12 MG TABLET Generic $0.44 each
GALANTAMINE HBR 4 MG TABLET Generic $0.34 each
GALANTAMINE HBR 8 MG TABLET Generic $0.66 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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