II. Indication

III. Mechanism

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

IV. Pharmacokinetics

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

V. Dosing

  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

VI. Adverse Effects

  1. See Acetylcholinesterase Inhibitor
  2. Bradycardia has also been reported with Galantamine

VII. 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]

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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