Galantamine:: a novel cholinergic agent for Alzheimer's disease

Galantamine has been recently approved for the symptomatic treatment of Alzheimer's disease (AD). Apart from inhibiting acetylcholinesterase, galantamine modulates the nicotinic receptors, although the clinical significance of this action remains uncertain. Through a broad research program, it has been shown that galantamine produces a cognitive, functional and behavioral benefit in patients with either mild or moderate AD. Initially, the maintenance dose must be 16 mg a day. Later on, 24 mg dose attempts are justified on an individual patient basis. A clinical stabilization for almost one year is observed. After that time, treated patients deteriorate at a similar pace than the non-treated ones, but they remain above the non-treated during at least one more year. Additional data suggest that positive effects of galantamine spread both caregiver burden and pharmacoeconomic areas. Tolerability is good, provided that titration is made slowly. The only contraindications of this drug are atrioventricular blockade and uncontrolled bronchospasm. Galantamine has also shown efficacy in mixed dementia. New possible indications are mild cognitive impairment and vascular dementia.