galantamine hydrobromide: clinical use

Prescribing considerations

• Confirm probable Alzheimer-type dementia before treatment and ensure suitable supervision of medicine administration.
• Regularly reassess clinical benefit, tolerability and adherence.
• Review cardiac disease, electrolyte disturbance, peptic-ulcer risk, seizures, respiratory disease, urinary obstruction and recent gastrointestinal or bladder surgery.
• Review concurrent medicines, particularly those affecting heart rate, QT interval, cholinergic activity or CYP2D6/CYP3A4.

Contraindications and cautions

• Hypersensitivity to galantamine or product excipients.
• Severe hepatic impairment.
• Creatinine clearance below the product-defined threshold.
• Combined significant renal and hepatic dysfunction.

Monitoring

• Weight and appetite.
• Nausea, vomiting, diarrhoea and hydration.
• Pulse, syncope and other cardiac symptoms.
• Renal and hepatic function when clinically relevant.
• Cognition, function, behaviour, adherence and ongoing treatment benefit.
• New rash or features of a serious skin reaction.

Clinical pharmacology

A selective, competitive and reversible acetylcholinesterase inhibitor that also enhances acetylcholine activity at nicotinic receptors. It is partly metabolised through CYP2D6 and CYP3A4 and is also eliminated renally.

Formulation and product differences

• Prolonged-release capsules must be swallowed whole rather than chewed or crushed.
• The oral solution is measured using the supplied graduated pipette and contains methyl parahydroxybenzoate, which may cause delayed allergic reactions.
• Switching between formulations should be clinician-directed to avoid duplication or administration errors.

Capsule

Route: Oral

Strengths: 8 mg, 24 mg

Modified-release capsule

Route: Oral

Strengths: 8 mg, 16 mg, 24 mg