Galantamine
RAZADYNE
Pronunciation: ga-LAN-ta-meen
“Go lantern! Raise a dyin’ (brain)”
baby blue theme → muscarinic
What it isAcetylcholinesterase inhibitor and neuronal nicotinic-receptor modulator; symptomatic treatment of Alzheimer dementia.
Why it mattersUnique among cholinesterase inhibitors in positively modulating neuronal nicotinic receptors, though outcomes resemble its peers.
What it changesBradycardia, syncope, and GI intolerance end trials; renal or hepatic impairment limits use.
Pearls
- Take with meals; titrate every 4 weeks to limit GI effects and weight loss.
- CrCl <60 or moderate hepatic impairment: max 16 mg/day; avoid if severe.
- No added benefit when combined with memantine.
Galantamine prescription history
Animated chart of estimated U.S. prescriptions per year, Dementia meds (1993–2026). Galantamine enters in 2001 (estimated).
FDA-approved for
- Alzheimer dementia (2001)
Principal riskBradycardia and GI intolerance
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityBradycardia, syncope or GI effects for symptomatic drugs; anti-amyloid agents add edema/hemorrhage risk.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Alzheimer's dementia (mild–moderate) | Adults | 4 mg BID | 8–12 mg BID (16–24 mg/day) | 24 mg/day (recommended range 16–24 mg/day) |
Titration Increase to next dose after a minimum of 4 weeks at the prior dose
Renal Do not exceed 16 mg/day for CrCl 9–59 mL/min; do not use if CrCl <9 mL/min
Hepatic Do not exceed 16 mg/day in moderate impairment; do not use in severe impairment
Instructions
- Take with food; ensure adequate fluid intake
- If therapy interrupted ≥3 days, restart at the lowest dose and re-titrate
Available strengths
- tab 4, 8, 12 mg
- ER cap 8, 16, 24 mg
- sol 4 mg/mL
Cautions
- Serious skin reactions (SJS, AGEP) — discontinue at first rash
- Bradycardia and AV block (vagotonic effects)
- GI bleeding — risk in ulcer-prone patients
- Bladder outflow obstruction
- Respiratory events in severe asthma/COPD
- Exaggerated neuromuscular blockade during anesthesia
Adverse reactions
- Nausea
- Vomiting
- Diarrhea
- Dizziness
- Headache
- Decreased appetite
Pregnancy No adequate human data; developmental toxicity in animals at clinical doses
Lactation Undefined
Cost
Generic entry2008
Open Galantamine in the interactive console ↗
Memory aids: interaction avatars
Open Galantamine in the interactive console ↗
Self-check
- Which extra receptor action distinguishes galantamine among cholinesterase inhibitors?
Positive neuronal nicotinic modulation. - Which cardiac adverse effect can end a galantamine trial?
Bradycardia.