Galantamine

About Galantamine

Galantamine reversibly blocks cholinesterase, the enzyme that breaks down the brain chemical acetylcholine, and is thought to work by raising acetylcholine levels; there is no evidence that it changes the course of the underlying disease. Its label covers mild to moderate dementia of the Alzheimer’s type. Tablets and oral solution start at 4 mg twice a day, preferably with the morning and evening meals, rise to 8 mg twice a day after at least four weeks, and a further step to 12 mg twice a day is tried after at least four more weeks; the recommended range is 16 to 24 mg a day. Extended-release capsules start at 8 mg once a day in the morning, preferably with food, and step up the same way to 16 and then 24 mg. Someone switching from tablets takes the last tablet in the evening and the capsule, at the same daily total, the next morning.

There is no boxed warning. Nausea, vomiting, diarrhea, dizziness, headache, decreased appetite and weight loss are the most common side effects, so weight is watched. The label warns of serious skin reactions, including Stevens-Johnson syndrome and acute generalized exanthematous pustulosis, and says to stop it at the first sign of a rash unless the rash is clearly unrelated. It can slow the heart and cause heart block in people with or without known heart rhythm problems, and fainting becomes more likely as the dose rises, so the label treats every patient as at risk. It can raise stomach acid, so an ulcer history or regular NSAID use calls for watching for bleeding; it may also cause seizures or difficulty passing urine, and it is prescribed with care in severe asthma or obstructive lung disease, with breathing watched closely. The only contraindication is allergy to galantamine or the product’s other ingredients.

Kidney and liver function set a ceiling: with moderate liver impairment (Child-Pugh 7 to 9) or a creatinine clearance of 9 to 59 mL/min the dose generally stays at or below 16 mg a day, and it is not recommended with severe liver impairment or a creatinine clearance below 9 mL/min. If treatment stops for more than three days, it is restarted at the lowest dose and stepped back up to the current dose. The label covers Alzheimer’s dementia only; in two two-year studies in mild cognitive impairment, more people died on galantamine than on placebo. It is likely to strengthen succinylcholine-type muscle relaxants used in anesthesia, so the anesthesia team needs to know about it.

Taking Galantamine

How to take it

Tablets and oral solution twice a day, preferably with breakfast and the evening meal; extended-release capsules once a day in the morning, preferably with food, swallowed whole and never crushed, chewed, broken or opened. Drink enough fluid during treatment. Measure the solution with the oral syringe supplied, empty it into 3 to 4 ounces of a nonalcoholic drink, stir, and drink it all right away.

If you miss a dose

Take a missed dose when you remember unless the next one is almost due; then skip it, and never take extra to make up for it. If you have stopped it for any reason, talk with the prescriber before restarting; after more than three days off, the label restarts it at the lowest dose.

Storage

At room temperature, away from moisture and heat; do not let the oral solution freeze.

Interactions to know about

It can interfere with anticholinergic medicines, such as antihistamine allergy and cold remedies, bladder medicines like oxybutynin and tolterodine, and some motion-sickness, stomach and Parkinson’s medicines. Other cholinesterase inhibitors, succinylcholine and cholinergic drugs such as bethanechol add to its effects. Ketoconazole and paroxetine raise its levels, and anyone taking NSAID pain relievers regularly is watched for stomach bleeding.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Galantamine differs from pharmacy to pharmacy

With both Razadyne brands discontinued, every quote is for a generic, so quotes differ mainly by maker, pharmacy fee and markup. The three forms are separate products: twice-daily tablets, the oral solution sold by the bottle, and once-daily extended-release capsules. A pharmacy that rarely fills one of them may need to order it in, and the form and strength on the prescription change what is quoted.

Ways to pay less for Galantamine without insurance

• Ask whether galantamine tablets are on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If the capsule or the oral solution is quoted high, ask the prescriber whether twice-daily tablets would suit you; changing forms is their decision.
• Once the dose is settled, ask for a ninety-day supply, since a gap of more than three days means starting again at the lowest dose.
• If cost is still a barrier, ask the prescriber whether another medicine in the same class, such as donepezil or rivastigmine, would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Galantamine

1. 1.Should my tablets be taken with breakfast and dinner, or my capsule with breakfast?
2. 2.What should happen if more than three days of doses are missed?
3. 3.Is my dose right for my kidney and liver function?
4. 4.Which rash, slow pulse or fainting symptoms mean I should call at once?

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