Galantamine: A New Alzheimer Drug with a Past Life

Abstract

OBJECTIVE: To review the historic, pharmacologic, pharmacokinetic, therapeutic, and toxicologic features of galantamine, a new acetylcholinesterase inhibitor, and to assess its role in the treatment of Alzheimer disease symptoms. DATA SOURCES: A search of articles was conducted using MEDLINE, TOXLINE, and the literature database PsychInfo, from 1966 to June 1999. The manufacturers, Janssen and SoPharm (Bulgaria), were contacted to obtain relevant preclinical data. Published textbooks of meeting symposia were also reviewed. STUDY SELECTION: Studies with animals and humans addressing preclinical pharmacology, human studies on pharmacokinetics, open clinical trials, and controlled studies were evaluated. DATA EXTRACTION: Relevant data were extracted from published studies and meeting abstracts only. DATA SYNTHESIS: Galantamine has an extensive record of activity as a reversal agent for neuromuscular blockade. Galantamine is also effective in the treatment of mild to moderate Alzheimer disease symptoms. Its efficacy versus similar Alzheimer treatment agents has yet to be determined. Adverse effects are gastrointestinal in nature and usually appear during the first weeks of therapy. CONCLUSIONS: Galantamine is a useful agent for the treatment of Alzheimer disease and for the reversal of neuromuscular blockade. It acts as both an acetylcholinesterase inhibitor and a nicotinic receptor agonist.