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Switch Safe from Donepezil to Galantamine: Presented at AGS

By Roberta Friedman

LAS VEGAS, NV -- May 19, 2004 -- Nearly all Alzheimer's patients switched from long term donepezil therapy to galantamine did so with little or no adverse effects, according to a 1-month follow-up study presented here May 18^th at the American Geriatric Society Annual Meeting.

Of 84 patients studied, 1 had noticeable cognitive decline when donepezil was ceased and galantamine was started. Three other patients reported confusion during step 2 of a 3-step procedure for making the switch.

"Usually patients had been on donepezil for a number of years, and [were] declining," said Pritesh Patel, MD, a fellow at Jersey Shore University Medical Center, Neptune, New Jersey, affiliated with Robert Wood Johnson Medical School. Dr. Patel said the impetus for switching usually comes from family members or when patients change facilities and formularies change.

Side effects of donepezil -- primarily gastrointestinal (GI) -- usually subside, but can reactivate if the patient has a change in condition, Dr. Patel said. Both agents are anticholinergics, with galantamine acting on the nicotinic as well as muscarinic sites. "A lot of patients don't tolerate [either of] these medications," he said, so both have to be titrated up carefully.

New drugs acting through glutamate transmission are in the pipeline or already approved, and these give "almost no nausea or GI side effects," Dr. Patel said.

For the switch, patients on 10 mg/kg of donepezil reduced the dose in half for 4 days, then stopped taking the drug. The next day, for step 2 of the protocol, they started taking 4 mg of galantamine 1 hour before dinner for 4 days. At step 3, another 4 mg dose was added, also with a meal. Any adverse reactions during steps 1 and 2 produced a return to donepezil.


[Presentation title: "Results of a next day crossover study of donepezil to galantamine in Alzheimer's disease patients: A one-month follow up study." Abstract 224.]

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