How does it work?
Reminyl tablets, Reminyl oral solution and Reminyl XL capsules all contain the active ingredient galantamine hydrobromide, which is a type of medicine called an acetylcholinesterase inhibitor. It works by slowing the breakdown of a compound in the body called acetylcholine.
Acetylcholine is a natural compound known as a neurotransmitter. Neurotransmitters are stored in nerve cells in the brain and nervous system, and are involved in transmitting messages between the nerve cells. They are necessary for the normal functioning of the brain and nervous system. Acetylcholine in the brain is continually being released by nerve cells, and then broken down by another natural chemical called acetylcholinesterase.
One of the features of Alzheimer's disease appears to be a lower than normal level of acetylcholine in the brain. This is due in part to degeneration of brain cells, in particular those that normally release acetylcholine.
Galantamine increases the level of acetylcholine in the brain. It does this by preventing the action of acetylcholinesterase, the compound which normally breaks it down. This slows the breakdown of acetylcholine that is released from remaining undamaged nerve cells in the brain.
Galantamine also enhances the activity of the acetylcholine in the brain. The overall result of these two actions is an improvement in the levels and activity of acetylcholine in the brain. This improves the cognitive processes of thinking, learning and memory, and improves the symptoms of dementia and daily functioning in Alzheimer's disease.
Galantamine is used to treat mild to moderately severe dementia in people with Alzheimer's disease. However, it only slows the worsening of the disease, rather than being a cure. The benefit of the medicine should be reassessed on a regular basis and treatment should be stopped when it is considered that the medicine is no longer providing a beneficial effect.
Reminyl tablets and oral solution are known as immediate release dose forms. This means that the medicine is absorbed into the bloodstream from the gut soon after they are taken. These dose forms are taken twice a day.
Reminyl XL capsules are known as prolonged release capsules. They are designed to release the medicine slowly over the day as the capsule passes through the gut. This means the capsules only need to be taken once a day, in the morning. The capsules should be swallowed whole with liquid and not chewed or crushed, as this would stop their prolonged release action from working.
What is it used for?
- Mild to moderately severe Alzheimer's disease.
- The benefit of this medicine in treating dementia or memory loss that are due to causes other than Alzheimer's disease has not been demonstrated. It should only be used to treat dementia that has been confirmed as Alzheimer's disease by a doctor experienced in treating Alzheimer's.
- A doctor will only prescribe this medicine if the patient has a caregiver available who will regularly make sure that the patient is taking the medicine.
- Reminyl tablets, Reminyl oral solution and Reminyl XL capsules should be taken with or after food. Reminyl XL capsules should be swallowed whole with liquid and not chewed or crushed, as this would stop their prolonged release action from working.
- This medicine may cause sleepiness and dizziness, particularly in the first few weeks after treatment is started. Care should be taken when performing potentially hazardous activites.
- People with Alzheimer's disease lose weight. This medicine may also cause weight loss. For this reason body weight should be regularly monitored in people taking this medicine.
Use with caution in
- Moderately reduced liver function.
- Disease involving the heart and blood vessels (cardiovascular disease).
- People who have recently had a heart attack.
- Irregular heartbeat caused by very rapid contraction of the top two chambers of the heart (atrial fibrillation).
- Unstable angina pectoris.
- Defect of the heart's electrical message pathways resulting in decreased function of the heart (heart block).
- Heart failure.
- A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome).
- Disturbances in the level of potassium in the blood.
- Disease involving the blood vessels in the brain (cerebrovascular disease), such as a history of stroke or mini-stroke (TIA).
- Parkinson's disease.
- History of chronic obstructive pulmonary disease (COPD).
- History of severe asthma.
- Active lung infections, eg pneumonia.
- People with a history of peptic ulcers, or an increased risk of developing a peptic ulcer, for example due to treatment with non-steroidal anti-inflammatory drugs (NSAIDs, eg ibuprofen, diclofenac).
Not to be used in
- Severely decreased kidney function.
- Severely decreased liver function.
- This medicine is not recommended for people with obstruction of the stomach, intestines or urinary tract, or for people recovering from stomach, intestinal or bladder surgery.
- Reminyl tablets contain lactose and are not suitable for people with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption.
- Reminyl XL capsules contain sucrose and are not suitable for people with fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine in pregnancy has not been established. It should therefore be used with caution during pregnancy, and only if the benefits to the mother outweigh any risks to the foetus. Seek medical advice from your doctor.
- It is not known if this medicine passes into breast milk. Mothers who need to take this medicine should not breastfeed. Seek medical advice from your doctor.
- Take this medication with or after food.
- Warning. May cause drowsiness. If affected do not drive or operate machinary.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
Very common (affecting more than 1 in 10 people)
Common (affecting between 1 in 10 and 1 in 100 people)
- Disturbances of the gut such as diarrhoea, indigestion or abdominal pain.
- Loss of appetite and weight loss.
- Fatigue or sleepiness.
- Difficulty sleeping (insomnia).
- Inflammation of the lining of the nose (rhinitis) causing a blocked or runny nose.
- Urinary tract infections.
- Raised blood pressure (hypertension).
Uncommon (affecting between 1 in 100 and 1 in 1000 people)
- Pins and needles sensations.
- Sensation of ringing or other noise in the ears (tinnitus).
- Abnormal heart beats.
- Decreased blood flow to the heart or brain (possibly causing heart attack or mini-stroke).
- Leg cramps.
Rare (affecting between 1 in 1000 and 1 in 10,000 people)
- Dehydration (possibly leading to kidney problems).
- Decreased amount of potassium in the blood (hypokalaemia).
- Slow heart rate (bradycardia).
- Aggression or agitation.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines the patient is already taking, including those bought without a prescription and herbal medicines, before they start treatment with this medicine. Similarly, check with your doctor or pharmacist before any new medicines are taken with this one, to ensure that the combination is safe.
Galantamine should not be taken with other medicines that increase the activity of acetylcholine, as this may increase the risk of side effects. These medicines include the following:
- other cholinergic medicines for Alzheimer's, eg donepezil
- pilocarpine tablets.
Galantamine will oppose the effects of medicines that work by blocking or decreasing the actions of acetylcholine (anticholinergic medicines). These medicines include the following:
- anticholinergics for Parkinson's disease, eg trihexyphenidyl, procyclidine
- anticholinergics for urinary incontinence, eg oxybutinin, tolterodine.
Galantamine has the potential to slow down the heart rate. This effect may be enhanced if it is taken with other medicines that have this effect, for example those listed below:
- beta-blockers such as atenolol, propranolol
- calcium channel blockers such as verapamil, diltiazem
The following medicines may increase the blood level of galantamine. As this may increase side effects such as nausea and vomiting, the doctor may reduce the dose of galantamine for people taking any of these:
- the SSRI antidepressants paroxetine, fluoxetine and fluvoxamine.
Other medicines containing the same active ingredient
There are currently no other medicines available in the UK that contain galantamine as the active ingredient.