Formulary
Galantamine: Indications, Dosing, Side Effects and Interactions
Galantamine is a reversible inhibitor of acetylcholinesterase and it also has nicotinic receptor agonist properties.
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Galantamine: Indications, Dosing, Side Effects and Interactions
Galantamine is a reversible inhibitor of acetylcholinesterase and it also has nicotinic receptor agonist properties.
Drug action
Galantamine is a reversible inhibitor of acetylcholinesterase and it also has nicotinic receptor agonist properties.
Indications and dose
**Mild to moderately severe dementia in Alzheimer's disease**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 4 mg twice daily for 4 weeks, increased to 8 mg twice daily for at least 4 weeks; maintenance 8-12 mg twice daily.
- **Adult** (By Mouth Using Modified-Release Capsules): Initially 8 mg once daily for 4 weeks, increased to 16 mg once daily for at least 4 weeks; maintenance 16-24 mg daily.
Cautions
Avoid in gastro-intestinal obstruction; avoid in urinary outflow obstruction; avoid whilst recovering from bladder surgery; avoid whilst recovering from gastro-intestinal surgery; cardiac disease; chronic obstructive pulmonary disease; congestive heart failure; electrolyte disturbances; history of seizures; history of severe asthma; pulmonary infection; sick sinus syndrome; supraventricular conduction abnormalities; susceptibility to peptic ulcers; unstable angina Cautions, further information Elderly For acetylcholinesterase inhibitors, Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate in patients with a known history of persistent bradycardia (heart rate less than 60 beats per minute), heart block, recurrent unexplained syncope, or concurrent treatment with drugs that reduce heart rate (risk of cardiac conduction failure, syncope, and injury).
Side effects
Common or very common Appetite decreased; arrhythmias; asthenia; depression; diarrhoea; dizziness; drowsiness; fall; gastrointestinal discomfort; hallucinations; headache; hypertension; malaise; muscle spasms; nausea; skin reactions; syncope; tremor; vomiting; weight decreased Uncommon Atrioventricular block; dehydration; flushing; hyperhidrosis; hypersomnia; hypotension; muscle weakness; palpitations; paraesthesia; seizure; taste altered; tinnitus; vision blurred Rare or very rare Hepatitis; severe cutaneous adverse reactions (SCARs)
Interactions
**Severe interactions:**
- As expected with cholinomimetics, a pharmacodynamic interaction is possible with medicinal products that significantly reduce the heart rate such as digoxin, beta-blockers, certain calcium-channel...
**Other interactions (12):**
- Pharmacodynamic interactions Because of its mechanism of action, galantamine should not be given concomitantly with other cholinomimetics (such as ambenonium, donepezil, neostigmine, pyridostigmine,...
- Galantamine has the potential to antagonise the effect of anticholinergic medication.
- Galantamine, as a cholinomimetic, is likely to exaggerate succinylcholine-type muscle relaxation during anaesthesia, especially in cases of pseudocholinesterase deficiency.
- Pharmacokinetic interactions Multiple metabolic pathways and renal excretion are involved in the elimination of galantamine.
- Concomitant administration with food slows the absorption rate of galantamine but does not affect the extent of absorption.
- It is recommended that Galantamine Krka be taken with food in order to minimise cholinergic side effects.
Pregnancy
Use with caution-toxicity in animal studies.
Breast feeding
Avoid-no information available.
Hepatic impairment
Manufacturer advises caution in moderate impairment (risk of increased plasma concentrations); avoid in severe impairment (no information available). Dose adjustments Manufacturer advises for immediate-release preparations in moderate impairment, initially 4 mg once daily (preferably in the morning) for at least 7 days, then 4 mg twice daily for at least 4 weeks; maximum 8 mg twice daily. Manufacturer advises for modified-release preparations in moderate impairment, initially 8 mg on alternate days (preferably in the morning) for 7 days, then 8 mg once daily for 4 weeks; maximum 16 mg daily.
Renal impairment
Avoid if creatinine clearance less than 9 mL/minute (no information available). M See Prescribing in renal impairment .
Medicinal forms
Tablet,Tablet,Capsule,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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