What is Galantamine?
It is often taken as a lucid dreaming aid and to make it easier to fall asleep after a stressful or anxiety-filled day. Galantamine is the generic name for the brand Reminyl which is used to treat mild to moderate confusion (dementia) related to Alzheimer’s disease.
√ Increases acetylcholine levels to support memory
√ Enhances mental clarity and attention span
√ Helps induce lucid dreaming states
Galantamine is responsible for a number of Nootropic benefits. A number of users indicate that taking this supplement has also led to an increased attention span, improved concentration and focus, including improved decision making.
Galantamine is the active ingredient in the popular brand named Reminyl, a recognised treatment for those suffering with Alzheimer’s Disease (AD).
A significant factor in Alzheimer’s Disease (AD) is the depletion of a neurotransmitter called acetylcholine. Galantamine helps to prevent the breakdown of acetylcholine, therefore assisting brain function and slowing down the effects of AD. Galantamine is a widely used treatment for the early stages of dementia / AD.
Galantamine crosses the blood-brain barrier and has been used in humans for decades in treatment of memory impairments, particularly those having a vascular origin. This supplement can improve memory formation and recall, enhance learning capacity, increase attention span and even improve mood. Galantamine may be used on its own or combined with choline supplements for increased effects.
Galantamine is also marketed under a number of different brand names including Nivalin, Razadyne, Reminyl (ER), and Lycoremine.
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The Lucid Dream Pill
Additional benefits of this supplement relate to how it may improve or influence sleep patterns. Taking a Galantamine dose later in the day is proven to help an individual in falling asleep more quickly and improving sleep quality.
Galantamine has also been found to increase dreaming activity which can have a positive effect on memory retention. Other people use this supplement to promote a state of lucid dreaming. In this state, a person will be aware that they are dream and have the ability to control the dream while they are experiencing it.
Galantamine Uses & Method of Action
Galantamine is derived from plants such as the snowdrop and the red spider lily, which have been used for hundreds of years to aid brain function / memory. In pharmaceutical form Galantamine is used to treat some recognised symptoms of AD reducing the mental and physical effects of the AD causing dementia.
By preventing the breakdown of acetylcholine Galantamine benefits those at the mild to moderate stages of AD. In this mechanism of action Galantamine is similar to other dementia drugs such as deprenyl or centrophenoxine. When treating neurodegenerative disorders, doses often have to be regularly increased to achieve the same effect but this is not the case with Galantamine which both protects acetylcholine and stimulates certain brain cell receptors. This dual action serves to make Galantamine one of the safest, most efficient forms of dementia therapy available today.
The usual recommended starting dose of galantamine is 8 mg once daily. After at least 4 weeks of treatment, the dose may be increased to 16 mg once daily. After at least 4 more weeks of treatment, the dose may be increased further to 24 mg once daily.
Galantamine capsules should be taken once daily in the morning with food.
It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Galantamine Side Effects
There are very few side effects recorded when using Galantamine but as with many medications used to treat dementia / AD, there is a risk of nausea, dizziness, vomiting, increased respiration and reduced blood pressure. This is due to the drug’s mechanism of action in the body.
Do not use if you suffer from chronic schizophrenia. As with all products of this nature, please seek medical advice and guidance from your physician or healthcare advisor before using.
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, and any other significant facts about your health. These factors may affect how you should use this medication.
Bladder problems: Galantamine can make it more difficult to empty the bladder and may contribute to urinary tract problems. If you have bladder problems or a history of urinary tract problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Drowsiness/reduced alertness: Galantamine may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.
Gender: Women are more likely to experience side effects such as nausea and vomiting. This is also more likely to happen for women who are underweight.
Liver function: If you have liver disease or reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Galantamine is not recommended for people with severely reduced liver function.
Heart disease: Galantamine can cause slowed heart rate, affecting people with congestive heart failure (CHF) or coronary artery disease (CAD). If you have a heart condition, including blood pressure problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Kidney function: If you have kidney disease or decreased kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Galantamine is not recommended for people with severely reduced kidney function.
Lung disease: Galantamine can worsen the symptoms of breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD) emphysema, and bronchitis. If you have asthma, COPD, or any other breathing problem, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Stomach ulcers: Galantamine can cause an increase in the amount of acid produced by the stomach, increasing the risk for stomach ulcers. If you have or have had stomach problems, or take nonsteroidal anti-inflammatory (NSAIDs) medications, you are at increased risk of stomach problems with this medication. If you have any of these conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Seizures: An increase in seizures has been reported by people taking galantamine. It is unclear whether this is because of the medication or the Alzheimer’s disease. If you have or have had a seizure disorder, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if galantamine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children. Galantamine is not intended to be used by children.
Seniors: People over 85 years of age may be at risk of more extreme weight loss when taking galantamine.
Galantamine Clinical Findings
More than 90 clinical trials have evaluated galantamine’s effect on Alzheimer’s and other conditions. Overall, they find a consistent symptomatic benefit on cognition and clinical measures in AD for several years of treatment; however, as with all cholinesterase inhibitors, galantamine’s effect size is small.
For example, in a six-month study of 653 patients with mild to moderate AD, 24 or 32 mg/day of galantamine led to a roughly 3-point treatment effect over placebo on both the ADAS-cognition scale and the CIBIC-plus and DAD scales of global clinical impression (Wilcock et al., 2000). A separate, five-month study of 978 patients with mild to moderate Alzheimer’s compared placebo to galantamine slowly escalated up to final doses of 16 and 24 mg/day. It similarly showed a 3- to 3.6-point treatment effect on ADAS-cog, as well as benefits in global clinical function, behavioral symptoms, and activities of daily living (Tariot et al., 2000).
After galantamine was approved, trials assessed whether it affected behavioral symptoms in patients with mild to moderate Alzheimer’s disease. Post-hoc analysis of data on 2,033 patients, pooled from three separate studies, suggested a galantamine treatment benefit as measured by the Neuropsychiatric Inventory (NPI), particularly on symptoms of agitation, anxiety, disinhibition, and aberrant movements; a subsequent analysis of four trials found much the same result (Herrmann et al., 2005; Kavanagh et al., 2011). Other postmarketing studies evaluated additional aspects of galantamine treatment in Alzheimer’s disease, for example the drug’s effect on attention and its efficacy in mild AD (Vellas et al., 2005; Orgogozo et al., 2004).
Several studies assessed galantamine’s long-term efficacy. Overall, they reported modest but consistent cognitive and clinical benefits of continuous treatment over three to four years (e.g., Raskind et al., 2004). Claims that long-term galantamine treatment delays a patient’s placement in a nursing home have been reported at conferences (see company press release); similar studies have been published in the peer-reviewed literature (Feldman et al., 2009).
A separate question concerns whether older patients and patients with advanced disease respond as well to cholinesterase treatment as do patients in their 70s and those with mild to moderate disease. An analysis of data on patients 80 and older, pooled from four different Phase 3 trials, suggested a treatment benefit for galantamine in patients in that age group (Marcusson et al., 2003). A retrospective analysis of data pooled from four three- to six-month trials reported a treatment benefit for moderate to severe Alzheimer’s disease, as did the subsequent, international SERAD study specifically on severe AD (Wilkinson et al., 2002; Burns et al., 2009).
In 2005, safety flags were raised temporarily when more deaths occurred in the galantamine than placebo groups in two mild cognitive impairment trials, and the drug’s prescribing information was updated accordingly (see Jan 2005 news story; WHO Pharmaceuticals newsletter). Subsequent meta-analysis contradicted this finding (e.g., Feldman et al., 2009). In 2012, a separate two-year trial of 2,051 patients with mild to moderate AD reportedly found 8 to 24 mg per day of galantamine to be associated not only with less decline in cognition and function, but also with lower mortality than placebo (see company press release). This last study has not been published in the peer-reviewed literature.
Even so, while galantamine is no longer seen as raising mortality in MCI, it was found to be ineffective in that population both in the two original MCI trials and in a broader meta-analysis of MCI patients in the cholinesterase inhibitor clinical trial literature (see Winblad et al., 2008; Tricco et al., 2013).
Overall, the acetylcholinesterase therapies galantamine, donepezil, and rivastigmine are seen as having similar efficacy and safety, but few side-by-side comparisons have been conducted. One such trial, comparing galantamine to donepezil for one year, reported a slightly larger cognitive benefit and more caregiver relief for galantamine, with similar results on tolerability and activities of daily living (Wilcock et al., 2003). In clinical practice, galantamine—or donepezil or rivastigmine—is frequently prescribed in combination with the NMDA antagonist memantine (Atri 2011).
Phase 4 studies have also evaluated galantamine for conditions other than AD. These include vascular dementia, tardive dyskinesia, attention deficit hyperactivity disorder, post-traumatic headache, postoperative delirium, depression, Tourette’s syndrome, bipolar disorder, cognition in schizophrenia, and stroke. Development attempts for chronic fatigue and fibromyalgia have been discontinued. Galantamine is still being actively evaluated as a cognitive enhancer in bipolar disorder and schizophrenia, and as an aid to end nicotine or cocaine dependence. However, despite extensive testing of galantamine, as of 2014 its regulatory approval has not been expanded beyond its original indication of mild to moderate Alzheimer’s disease.
For some years after cholinesterase inhibitor therapies were initially approved for Alzheimer’s disease, their modest effect size created controversy about their cost-effectiveness (see Jul 2004 news story and extensive commentary). Pharmacoeconomic studies in the United States, Canada, and European countries have generally found that cholinesterase inhibitor treatment reduces the cost of care. In the United Kingdom, this debate called into question coverage of cholinesterase inhibitors by its universal health care system. The U.K.’s National Institute for Health and Care Excellence (NICE) in 2007 restricted use of these drugs, but in 2010 it re-evaluated the issue and in 2011 issued a guidance recommending the use of galantamine in the treatment of mild to moderate AD (see, e.g., Garfield et al., 2002; NICE guidance). Recent pharmacoeconomic studies confirm the cost-effectiveness of galantamine (e.g., Hyde et al., 2013).
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- Antioxidant activity of galantamine and some of its derivatives. – Read Full Article
- Long-term effects of galantamine on cognitive function in Alzheimer’s disease: a large-scale international retrospective study. – Read Full Article
- Increased glutamate in the hippocampus after galantamine treatment for Alzheimer disease. – Read Full Article
- Synergistic inhibition of butyrylcholinesterase by galantamine and citalopram. – Read Full Article
- Modelling the clinical and economic implications of galantamine in the treatment of mild-to-moderate Alzheimer’s disease in Germany. – Read Full Article
- Galantamine inhibits calpain-calcineurin signaling activated by beta-amyloid in human neuroblastoma SH-SY5Y cells. – Read Full Article
- Effects of galantamine on Î²-amyloid release and beta-site cleaving enzyme 1 expression in differentiated human neuroblastoma SH-SY5Y cells. – Read Full Article.