Reminyl ER

Reminyl ER Uses, Dosage, Side Effects, Food Interaction and all others data.

Reminyl ER is a cholinomimetic agent. It is a competitive and reversible inhibitor of the enzyme acetylcholinesterase. In addition, Reminyl ER enhances the intrinsic action of acetylcholine on nicotinic receptors. As a result, an increased activity in the cholinergic system associated with improved cognitive function can be achieved in patients with dementia of the Alzheimer’s type.

Reminyl ER is a phenanthrene alkaloid and a reversible, competitive acetylcholinesterase inhibitor. It is not structurally related to other acetylcholinesterase inhibitors. Reminyl ER's proposed mechanism of action involves the reversible inhibition of acetylcholinesterase, which prevents the hydrolysis of acetycholine, leading to an increased concentration of acetylcholine at cholinergic synapses. Reminyl ER also binds allosterically with nicotinic acetylcholine receptors and may possibly potentiate the action of agonists (such as acetylcholine) at these receptors.

Reminyl ER is a competitive and reversible inhibitor of acetylcholinesterase that works to increase acetylcholine levels. Reminyl ER acts both centrally and peripherally to inhibit both muscle and brain acetylcholinesterase, thereby increasing cholinergic tone. Reminyl ER is also a positive allosteric modulator of neuronal nicotinic acetylcholine receptors. As dementia is a progressive neurodegenerative disease, galatamine has a negligible effect in altering the course of the underlying process of dementia and may exert its therapeutic effectiveness for a short period of time. However, galantamine promoted improvements in cognition, global function, activities of daily living, and behavioural symptoms in clinical studies of Alzheimer’s disease.

Reminyl ER exhibited therapeutic efficacy in studies of vascular dementia and Alzheimer’s disease with cerebrovascular disease. In one study, galantamine reversed scopolamine-induced acute anticholinergic syndrome that was characterized by drowsiness, disorientation, and delirium.

Trade Name Reminyl ER
Availability Prescription only
Generic Galantamine
Galantamine Other Names Galantamina, Galantamine, Galanthamine
Related Drugs donepezil, memantine, Aricept, Namenda, rivastigmine, Exelon
Type
Formula C17H21NO3
Weight Average: 287.3535
Monoisotopic: 287.152143543
Protein binding

The plasma protein binding of galantamine is 18% at therapeutically relevant concentrations.

Groups Approved
Therapeutic Class Drugs for Dementia
Manufacturer
Available Country Canada, United States
Last Updated: September 19, 2023 at 7:00 am
Reminyl ER
Reminyl ER

Uses

Reminyl ER is used for the treatment of mild to moderate dementia of the Alzheimer’s type.

Reminyl ER is also used to associated treatment for these conditions: Mild to Moderate Dementia Due to Alzheimer's Disease, Mild Dementia of the Alzheimer's Type, Moderate Alzheimer's Type Dementia

How Reminyl ER works

Alzheimer’s disease is characterized by progressive, irreversible degeneration of acetylcholine-producing neurons, cognitive impairment, and the accumulation of neurofibrillary tangles and amyloid plaques. The cholinergic system plays a critical role in memory, alongside other important neural functions such as attention, learning, stress response, wakefulness and sleep, and sensory information. Studies show that acetylcholine (ACh) is involved in the modulation of acquisition, encoding, consolidation, reconsolidation, extinction, and retrieval of memory. The gradual loss of cholinergic neurons in Alzheimer’s disease (AD) may, therefore, contribute to the memory loss exhibited by AD patients.

Acetylcholinesterase is secreted by cholinergic neurons to rapidly hydrolyze ACh at the synaptic cleft to release acetate and choline. Choline is later recycled back into the presynaptic cholinergic neuron via reuptake by the high-affinity choline transporter. There is some evidence demonstrating the potential involvement of the acetylcholinesterase enzyme in the formation of amyloid fibrils. Reminyl ER competitively and reversibly inhibits the anticholinesterase enzyme in the CNS (namely in the frontal cortex and hippocampal regions) by binding to the choline-binding site and acyl-binding pocket of the enzyme active site. By blocking the breakdown of ACh, galantamine enhances ACh levels in the synaptic cleft.

Nicotinic acetylcholine receptors (nAChR) in the CNS are mostly expressed at the presynaptic neuronal membrane to control the release of multiple neurotransmitters, such as ACh, glutamate, GABA, dopamine, serotonin, norepinephrine. Agonists of nAChRs improve performance in cognitive tasks, while antagonists of nAChR impair cognitive processes. Some studies show a decrease in the expression and activity of nAChRs in patients with AD, which may explain the reduction in central cholinergic neurotransmission in these patients. Reminyl ER binds to nAChRs at the allosteric site, leading to a conformational change of the receptor, increased ACh release, and increased activity of neighbouring glutaminergic and serotoninergic neurons. The modulation of nAChRs facilitates both excitatory and inhibitory cholinergic transmissions in brain tissues and increases receptor sensitivity. The modulated release of other neurotransmitters by galantamine may also contribute to the upregulation of nAChRs and amelioration of behavioural symptoms in AD.

Dosage

Reminyl ER dosage

Adults: The recommended starting dose of Reminyl ER is 4 mg twice daily (8 mg/day). The dose should be increased to the initial maintenance dose of 8 mg twice daily (16 mg/day) after a minimum of 4 weeks. A further increase to 12 mg twice daily (24 mg/day) should be attempted after a minimum of 4 weeks at 8 mg twice daily (16 mg/day).

Reminyl ER tablets should be administered twice daily, preferably with morning and evening meals.

Side Effects

Common side effects are nausea, vomiting, diarrhoea, abdominal pain, dyspepsia; syncope; rhinitis; sleep disturbances, dizziness, confusion, depression, headache, fatigue, anorexia, tremor; fever; weight loss; less commonly arrhythmias, palpitation, myocardial infarction, cerebrovascular disease, paraesthesia, tinnitus, and leg cramps.

Toxicity

The oral LD50 of the active ingredient, galantamine hydrobromide, in rats is 75 mg/kg. Symptoms of overdose are expected to be similar to those of cholinomimetics, which involve the central nervous system, the parasympathetic nervous system, and the neuromuscular junction. Effects of a cholinergic crisis include severe nausea, vomiting, gastrointestinal cramping, salivation, lacrimation, urination, defecation, sweating, bradycardia, hypotension, respiratory depression, collapse, and convulsions. Muscle weakness or fasciculations may also occur, with respiratory muscle weakness having the potential to bring fatal results. In one patient who consumed an oral daily dose of 32 mg developed bradycardia, QT prolongation, ventricular tachycardia and torsades de pointes accompanied by a brief loss of consciousness. In one patient with a history of hallucinations who consumed a daily dose of 24 mg galantamine, hallucinations requiring hospitalization occurred. A patient who ingested 160 mg of galantamine from an oral solution developed sweating, vomiting, bradycardia, and near-syncope one hour following consumption.

As in any case of overdose, general supportive measures should be initiated. Tertiary anticholinergics such as intravenous atropine may be used to reverse the cholinergic effects of galantamine. The recommended initial dose of atropine intravenously administered for galantamine overdose ranges from 0.5 to 1.0 mg. It is not known whether galantamine can be removed by dialysis.

Precaution

Caution should be taken in patients with cardiac disease; electrolyte disturbances; susceptibility to peptic ulcers; asthma, chronic obstructive pulmonary disease, pulmonary infection. Reminyl ER should be avoided in urinary retention and gastro-intestinal obstruction.

Interaction

ay antagonise the effect of other cholinomimetics (e.g. donepezil, neostigmine, systemic pilocarpine). Pharmacodynamic interaction w/ drugs that significantly reduce the heart (e.g. digoxin, β-blockers, certain Ca-channel blocking agents and amiodarone). May exaggerate succinylcholine-type muscle relaxation during anaesth, esp in pseudocholinesterase deficiency.

Food Interaction

  • Take with food. Food delays the rate of absorption but not the extent.

Volume of Distribution

The mean volume of distribution is 175 L. About 52.7% of galantamine is distributed to blood cells, the blood to plasma concentration ratio of galantamine is 1.2. Reminyl ER penetrates the blood–brain barrier.

Elimination Route

Over a dose range of 8-32 mg/day, galantamine exhibits a dose-linear pharmacokinetic profile. The oral bioavailability of galantamine ranges from 90-100%. Following oral administration, the Tmax is about 1 hour. Following 10 hours of administration, the mean galantamine plasma concentrations were 82–97 µg/L for the 24 mg/day dose and 114–126 µg/L for the 32 mg/day dose.

Half Life

Reminyl ER has a terminal half-life of about 7 hours.

Clearance

The renal clearance is 65 mL/min and the total plasma clearance is about 300 mL/min.

Elimination Route

Renal clearance accounts for about 20–25% of total plasma clearance of the drug in healthy individuals: the elimination of galantamine has been shown to be decreased in subjects with renal impairment. Following oral or intravenous administration, approximately 20% of the dose is excreted as unchanged in the urine within 24 h. In a radiolabelled drug study, about 95% and 5% of the total radioactivity was recovered in the urine and feces, respectively. Of the dose recovered in the urine, about 32% was in the unchanged parent compound, and 12% was in the glucuronide form.

Pregnancy & Breastfeeding use

Pregnancy category B. Reminyl ER should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It should not be used during breast-feeding. However, if its use is unavoidable, then breast-feeding should be discontinued.

Contraindication

Reminyl ER is contraindicated in patients with renal impairment; breast feeding and known hypersensitivity to the active substance or to any of the excipients

Special Warning

Children: Reminyl ER is not recommended in children.

Hepatic impaired patients: In patients with moderately impaired hepatic function, the total daily dose should generally not exceed 16 mg/day. The use of Reminyl ER in patients with severe hepatic impairment is not recommended.

Renal impaired patients: For patients with moderate renal impairment the dose should generally not exceed 16 mg/day. In patients with severe renal impairment (creatinine clearance <9 mL/min), the use of Reminyl ER is not recommended.

Acute Overdose

Symptoms: Muscle weakness or fasciculations, severe nausea, vomiting GI cramping, salivation, lacrimation, urination, defecation, sweating, bradycardia, hypotension, collapse and convulsions.

Management: General supportive measures. Anticholinergics such as atropine (with initial dose of 0.5-1 mg IV) may be used as general antidote.

Storage Condition

Store in a cool and dry place. Protect from light.

Innovators Monograph

You find simplified version here Reminyl ER

Reminyl ER contains Galantamine see full prescribing information from innovator Reminyl ER Monograph, Reminyl ER MSDS, Reminyl ER FDA label

*** Taking medicines without doctor's advice can cause long-term problems.
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