Drug Interactions between galantamine and glycopyrrolate / neostigmine
This report displays the potential drug interactions for the following 2 drugs:
- galantamine
- glycopyrrolate/neostigmine
Interactions between your drugs
neostigmine glycopyrrolate
Applies to: glycopyrrolate / neostigmine and glycopyrrolate / neostigmine
Ask your doctor before using neostigmine together with glycopyrrolate. Using these medications together can cause increasing muscle weakness. In addition, such use may mask the less serious, gastrointestinal signs of glycopyrrolate overdose and lead to difficulty breathing, chest pain, and possibly death. If your doctor prescribes these medications together, you may need a dose adjustment or special tests to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
neostigmine galantamine
Applies to: glycopyrrolate / neostigmine and galantamine
Using neostigmine together with galantamine can increase the blood levels or add to the side effects of either medication. This can cause nausea, vomiting, diarrhea, abdominal pain, increased salivation, cold sweats, slow or irregular heartbeat, muscle weakness or cramps, dizziness, headache, seizures, or breathing problems. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
glycopyrrolate galantamine
Applies to: glycopyrrolate / neostigmine and galantamine
Using galantamine together with glycopyrrolate may decrease the benefits of galantamine in the treatment of dementia. Galantamine may also counteract the benefit of glycopyrrolate. Glycopyrrolate should generally be avoided in patients with Alzheimer's disease or other cognitive problems. Glycopyrrolate may also adversely affect elderly patients by producing symptoms ranging from mild thinking impairment to delirium. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor.
Drug and food interactions
galantamine food
Applies to: galantamine
Consumer information for this interaction is not currently available.
ADJUST DOSING INTERVAL: The administration of galantamine with food and adequate fluid intake may reduce the impact of nausea, vomiting, diarrhea, anorexia, and weight loss that are commonly associated with acetylcholinesterase inhibitors (AChEIs). According to product labeling, the administration of food with various galantamine formulations (e.g., liquid, immediate-release tablets, modified/extended-release capsules) has no significant effect on the systemic absorption (AUC) of galantamine. While the presence of food has been shown to delay the rate of absorption (Tmax) and reduce peak concentration (Cmax), these changes are unlikely to be clinically significant. For example, when galantamine modified release was given after food, Tmax increased by approximately 30 minutes. Similarly, in 24 healthy elderly subjects, the presence of food with galantamine immediate release tablets (12 mg twice a day) delayed the Tmax by 1.5 hours and decreased the Cmax by about 25% without affecting the AUC.
MONITOR: Grapefruit and grapefruit juice may increase the plasma concentrations of galantamine, which is partially metabolized by the CYP450 3A4 isoenzyme. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Inhibition of hepatic CYP450 3A4 may also contribute. The interaction has not been studied with grapefruit juice, but has been reported with both moderate and potent CYP450 3A4 inhibitors. When study subjects (n=16) received the potent CYP450 3A4 inhibitor ketoconazole (200 mg twice daily for 4 days) with galantamine (4 mg twice daily for 8 days), the systemic exposure (AUC) of galantamine increased by 30%. However, when study subjects (n=16) received the moderate CYP450 3A4 inhibitor erythromycin (500 mg 4 times daily for 4 days) with galantamine (4 mg twice daily for 6 days), the AUC of galantamine only increased by 10%. In general, the effects of grapefruit products are concentration-, dose-, and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. While the clinical significance of this interaction is unknown, increased exposure to galantamine may lead to AChEI related adverse effects such as vagotonic effects on the heart rate (e.g., bradycardia and heart block), neurologic side effects (e.g., seizure activity), respiratory distress, bladder outflow obstruction, dizziness or syncope, nausea, vomiting and/or diarrhea.
MANAGEMENT: According to product labeling, galantamine should be administered with food and adequate fluid intake to reduce the impact of cholinergic-related gastrointestinal adverse effects (e.g., nausea, vomiting, diarrhea, anorexia, and weight loss). Caution and closer monitoring for AChEI related adverse effects may advisable if galantamine is used in combination with grapefruit and/or grapefruit juice. Modified and/or extended-release formulations must also be swallowed whole and not crushed, chewed, or divided.
glycopyrrolate food
Applies to: glycopyrrolate / neostigmine
Ask your doctor before using glycopyrrolate together with ethanol. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking glycopyrrolate. You should be warned not to exceed recommended dosages and to avoid activities requiring mental alertness. If your doctor prescribes these medications together, you may need a dose adjustment to safely take this combination. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Therapeutic duplication warnings
Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.
Cholinergics
Therapeutic duplication
The recommended maximum number of medicines in the 'cholinergics' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'cholinergics' category:
- galantamine
- glycopyrrolate/neostigmine
Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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