Galantamine (Razadyne)

Class

Acetylcholinesterase inhibitor

Mechanism

Reversibly inhibits acetylcholinesterase, increasing acetylcholine levels and enhancing cholinergic neurotransmission; also modulates nicotinic receptors which may improve cognitive function

FDA-Approved Use

Mild to moderate Alzheimer’s disease (AD)

Off-Label Use

Vascular dementia, mild cognitive impairment (MCI), dementia with Lewy bodies (DLB), post-stroke apathy

Formulation

Immediate-release tablets, extended-release capsules, oral solution

Titration

Start 4–8 mg/day orally, titrate every 4 weeks as tolerated

Dose Range

8–24 mg/day in divided doses or once-daily extended release

Kinetics

Half-life approximately 7 hours; metabolized primarily via CYP2D6 and CYP3A4

Common AEs

Nausea, vomiting, diarrhea, weight loss, dizziness

Serious/Rare AEs

Rare cardiac conduction abnormalities and syncope

Monitoring

Monitor for gastrointestinal symptoms, weight changes, and cardiac effects

Black Box Warning

None

Considerations

May improve attention and executive function in vascular cognitive impairment and early AD. Use cautiously in patients with cardiac conduction abnormalities or history of syncope. Titrate slowly in elderly patients to minimize gastrointestinal and vagal side effects.