Interactions between Eskalith and Galantamine
1 drug interaction and 30 additional warnings found for the following 2 drugs:
- Eskalith (lithium)
- galantamine
Drug interactions
Moderate drug interactions
Moderate:
lithium galantamine
Applies to: Eskalith (lithium) and galantamine
Monitor
Acetylcholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes, which occasionally manifest as bradycardia or heart block (<2%). Because bradycardia is a risk factor for torsade de pointes, a theoretical risk exists when combined with agents that prolong the QT interval. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors including, but not limited to congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation may vary depending on the dosage(s) and specific drug(s) involved.
Management
Caution is advised when acetylcholinesterase inhibitors are used with drugs that can prolong the QT interval. Patients should be monitored for bradycardia, atrioventricular block and syncope, and advised to seek medical attention if they experience dizziness, lightheadedness, fainting, shortness of breath, or slow or irregular heartbeat.
References (12)
- (2001) "Product Information. Aricept (donepezil)." Pfizer U.S. Pharmaceuticals
- (2001) "Product Information. Exelon (rivastigmine)." Novartis Pharmaceuticals
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- Cerner Multum, Inc. "Australian Product Information."
- (2024) "Product Information. Galantamine Hydrobromide ER (galantamine)." Aurobindo Pharma USA Inc
- (2024) "Product Information. Galantamine Hydrobromide (galantamine)." Aurobindo Pharma USA Inc
- (2022) "Product Information. Gaalin (galantamine)." Auro Pharma Inc
- (2023) "Product Information. Galzemic (galantamine)." Zentiva Pharma UK Ltd
- (2023) "Product Information. Galantyl (galantamine)." Viatris UK Healthcare Ltd
- (2020) "Product Information. Auro-Galantamine ER (galantamine)." Auro Pharma Inc
- (2024) "Product Information. Zunveyl (benzgalantamine)." Alpha Cognition, Inc., SUPPL-1
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
lithium Food/Lifestyle
Applies to: Eskalith (lithium)
Generally avoid
Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
Management
Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
References (4)
- Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
- Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
- (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
- (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka America Pharmaceutical, Inc.
Moderate:
galantamine Food/Lifestyle
Applies to: galantamine
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.
References (6)
- (2024) "Product Information. Galantamine Hydrobromide ER (galantamine)." Aurobindo Pharma USA Inc
- (2024) "Product Information. Galantamine Hydrobromide (galantamine)." Aurobindo Pharma USA Inc
- (2022) "Product Information. Gaalin (galantamine)." Auro Pharma Inc
- (2023) "Product Information. Galzemic (galantamine)." Zentiva Pharma UK Ltd
- (2023) "Product Information. Galantyl (galantamine)." Viatris UK Healthcare Ltd
- (2020) "Product Information. Auro-Galantamine ER (galantamine)." Auro Pharma Inc
Moderate:
lithium Caffeine
Applies to: Eskalith (lithium)
Monitor
One study has suggested that caffeine withdrawal may significantly increase blood lithium levels. The mechanism may be involve reversal of a caffeine-induced increase in renal lithium excretion.
Management
When caffeine is eliminated from the diet of lithium-treated patients, caution should be exercised. When caffeine consumption is decreased, close observation for evidence of lithium toxicity and worsening of the psychiatric disorder is recommended. Patients should be advised to notify their physician if they experience symptoms of possible lithium toxicity such as drowsiness, dizziness, weakness, ataxia, tremor, vomiting, diarrhea, thirst, blurry vision, tinnitus, or increased urination.
References (1)
- Mester R, Toren P, Mizrachi I, Wolmer L, Karni N, Weizman A (1995) "Caffeine withdrawal increases lithium blood levels." Biol Psychiatry, 37, p. 348-50
Disease interactions
27 potential interactions Applies to: 23 conditions, including Underactive Thyroid, Asthma, COPD, Seizures, and Diarrhea.
Alcoholism
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Alcoholism.
Antipsychotics can lower the seizure threshold and trigger seizures in a dose-dependent manner. Seizures have been reported in patients receiving antipsychotic therapy and may occur in epileptic patients even with maintenance of routine anticonvulsant treatment. Therapy with antipsychotics should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. High dosages should be avoided if possible.
Arrhythmia
Major:
galantamine
Galantamine has a major potential interaction with Arrhythmia.
Due to their pharmacological action, cholinesterase inhibitors can have a vagotonic effect on the sinoatrial and atrioventricular nodes producing bradycardia or heart block. Therapy with cholinesterase inhibitors should be administered cautiously in patients with preexisting bradycardia or underlying cardiac conduction abnormalities. Syncopal episodes have been reported. Atropine may be used to reverse bradycardia produced by cholinesterase inhibitors.
Asthma
Major:
galantamine
Galantamine has a major potential interaction with Asthma.
Cholinesterase inhibitors inhibit the hydrolysis of acetylcholine. The enhanced effect of acetylcholine produces constriction of the bronchi, increased bronchial secretions, and bronchospasm. Therapy with cholinesterase inhibitors should be administered cautiously in patients with respiratory dysfunction, history of asthma, or obstructive pulmonary disease. Respiratory function should be closely monitored for the occurrence of respiratory adverse reactions. Use of atropine along with discontinuation of the cholinesterase inhibitor may be required for serious respiratory distress.
Breast Cancer
Moderate:
Eskalith
The lithium in Eskalith has a moderate potential interaction with Breast Cancer.
Antipsychotic drugs can elevate serum prolactin concentrations, and this elevation persists during chronic administration. This should be considered if therapy will be prescribed in patients with previously detected breast cancer as one-third of human breast cancers are prolactin-dependent in vitro. Associated disturbances such as galactorrhea, amenorrhea, gynecomastia, and impotence have been reported. Appropriate laboratory testing and follow-up is advised.
Cardiovascular Conditions and Disorders
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Cardiovascular Conditions and Disorders.
Lithium should generally not be given to patients with significant cardiovascular disease since the risk of lithium toxicity is high in these patients. Additionally, there have been postmarketing reports of a possible association between lithium therapy and the unmasking of Brugada Syndrome, a disorder characterized by abnormal EKG findings and a risk of sudden death. Lithium should be avoided in patients with this diagnosis or suspicion of it, or that have risk factors, which include unexplained syncope, family history of this syndrome, or family history of unexplained sudden death before the age of 45 years.
Therapy with lithium should be administered with extreme caution in patients with preexisting cardiac disease. Consultation with a cardiologist is highly recommended and cardiac monitoring should be completed before and during treatment.
Central Nervous System Disorders
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Central Nervous System Disorders.
Antipsychotics can lower the seizure threshold and trigger seizures in a dose-dependent manner. Seizures have been reported in patients receiving antipsychotic therapy and may occur in epileptic patients even with maintenance of routine anticonvulsant treatment. Therapy with antipsychotics should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. High dosages should be avoided if possible.
COPD
Major:
galantamine
Galantamine has a major potential interaction with COPD.
Cholinesterase inhibitors inhibit the hydrolysis of acetylcholine. The enhanced effect of acetylcholine produces constriction of the bronchi, increased bronchial secretions, and bronchospasm. Therapy with cholinesterase inhibitors should be administered cautiously in patients with respiratory dysfunction, history of asthma, or obstructive pulmonary disease. Respiratory function should be closely monitored for the occurrence of respiratory adverse reactions. Use of atropine along with discontinuation of the cholinesterase inhibitor may be required for serious respiratory distress.
Dehydration
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Dehydration.
Lithium reduces the ability of the kidney to concentrate urine and produces a mild diabetes insipidus and polyuria. Therefore, patients with preexisting dehydration are more prone to lithium retention and toxicity. Therapy with lithium should be administered cautiously in dehydrated patients and may need to be discontinued until improvement in hydration status. Careful monitoring of lithium levels are recommended. Patients with sweating, diarrhea or concomitant infection with fever may need a temporary reduction or cessation of medication.
Dementia
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Dementia.
Antipsychotic drugs are not approved for the treatment of patients with dementia-related psychosis. Older patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; although the causes were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. A causal relationship with antipsychotic use has not been established. In controlled trials in older patients with dementia-related psychosis, patients randomized to risperidone, aripiprazole, and olanzapine had higher incidence of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, compared to patients treated with placebo.
Diarrhea
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Diarrhea.
The risk for lithium toxicity may be increased in patients with diarrhea and excessive sweating. Dehydration and sodium depletion may occur in these patients leading to lithium retention and toxicity. The use of lithium may need to be reduced or suspended until the condition resolves. Supplemental fluid and salt may need to be administered. Monitoring serum lithium levels is recommended.
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Diarrhea.
Lithium reduces the ability of the kidney to concentrate urine and produces a mild diabetes insipidus and polyuria. Therefore, patients with preexisting dehydration are more prone to lithium retention and toxicity. Therapy with lithium should be administered cautiously in dehydrated patients and may need to be discontinued until improvement in hydration status. Careful monitoring of lithium levels are recommended. Patients with sweating, diarrhea or concomitant infection with fever may need a temporary reduction or cessation of medication.
Fever
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Fever.
Lithium reduces the ability of the kidney to concentrate urine and produces a mild diabetes insipidus and polyuria. Therefore, patients with preexisting dehydration are more prone to lithium retention and toxicity. Therapy with lithium should be administered cautiously in dehydrated patients and may need to be discontinued until improvement in hydration status. Careful monitoring of lithium levels are recommended. Patients with sweating, diarrhea or concomitant infection with fever may need a temporary reduction or cessation of medication.
Moderate:
Eskalith
The lithium in Eskalith has a moderate potential interaction with Fever.
Patients with fever may have a lower tolerance to lithium due to increased fluid and sodium loss. Lithium dosage may need to be reduced or suspended in such patients. Monitoring lithium serum levels is recommended.
Hyperhidrosis
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Hyperhidrosis.
Lithium reduces the ability of the kidney to concentrate urine and produces a mild diabetes insipidus and polyuria. Therefore, patients with preexisting dehydration are more prone to lithium retention and toxicity. Therapy with lithium should be administered cautiously in dehydrated patients and may need to be discontinued until improvement in hydration status. Careful monitoring of lithium levels are recommended. Patients with sweating, diarrhea or concomitant infection with fever may need a temporary reduction or cessation of medication.
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Hyperhidrosis.
The risk for lithium toxicity may be increased in patients with diarrhea and excessive sweating. Dehydration and sodium depletion may occur in these patients leading to lithium retention and toxicity. The use of lithium may need to be reduced or suspended until the condition resolves. Supplemental fluid and salt may need to be administered. Monitoring serum lithium levels is recommended.
Hyperprolactinemia
Moderate:
Eskalith
The lithium in Eskalith has a moderate potential interaction with Hyperprolactinemia.
Antipsychotic drugs can elevate serum prolactin concentrations, and this elevation persists during chronic administration. This should be considered if therapy will be prescribed in patients with previously detected breast cancer as one-third of human breast cancers are prolactin-dependent in vitro. Associated disturbances such as galactorrhea, amenorrhea, gynecomastia, and impotence have been reported. Appropriate laboratory testing and follow-up is advised.
Hyponatremia
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Hyponatremia.
Lithium decreases sodium reabsorption by the renal tubules which could lead to sodium depletion. Therapy with lithium should be administered cautiously in patients with preexisting sodium depletion as the risk of lithium toxicity is increased. Lower dosages may be required. Patients should maintain a normal diet, including salt, and an adequate fluid intake. Monitoring lithium serum concentrations is recommended.
Liver Disease
Moderate:
galantamine
Galantamine has a moderate potential interaction with Liver Disease.
In patients with moderate hepatic impairment (Child-Pugh score of 7 to 9), the dosage of galantamine or benzgalantamine should generally not exceed 16 mg/day or 20 mg/day, respectively. The use of galantamine or benzgalantamine in patients with severe hepatic impairment (Child-Pugh score of 10 to 15) is not recommended.
Neuroleptic Malignant Syndrome
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Neuroleptic Malignant Syndrome.
Neuroleptic Malignant Syndrome (NMS), a potentially fatal symptom complex, has been reported in association with the use of antipsychotic drugs. The diagnostic evaluation is complicated and the management requires immediate discontinuation of the antipsychotic therapy and intensive symptomatic treatment and medical monitoring. If a patient that has recovered from NMS requires antipsychotic drug treatment again, the reintroduction of therapy should be carefully considered as NMS recurrences have been reported.
Neutropenia
Moderate:
Eskalith
The lithium in Eskalith has a moderate potential interaction with Neutropenia.
The use of antipsychotics has been associated with events of leukopenia, neutropenia and agranulocytosis. Possible risk factors include preexisting low white blood cell count, and history of drug induced leukopenia/neutropenia. Patients with these risk factors should have complete blood count monitored frequently during the first few months of therapy. Patients should also be monitored for any signs or symptoms of infection. Treatment should be discontinued in any patient who develops a sore throat, fever, stomatitis, or other signs of infection along with a low WBC count or severe neutropenia (ANC < 1000/mm3).
Peptic Ulcer
Moderate:
galantamine
Galantamine has a moderate potential interaction with Peptic Ulcer.
The use of cholinesterase inhibitors is associated with an increase in gastric acid secretion and gastric contractions. Monitor for symptoms of active or occult gastrointestinal bleeding, especially in patients at increased risk for developing ulcers (e.g., history of ulcer disease or concurrent use of nonsteroidal anti-inflammatory drugs).
Renal Dysfunction
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Renal Dysfunction.
Lithium is primarily eliminated by the kidneys and should generally not be administered to patients with significant renal dysfunction. Additionally, morphological changes with glomerular and interstitial fibrosis and nephron atrophy have been reported in patients on chronic lithium therapy, although the association has not been clearly established. Kidney function should be assessed in patients prior to starting therapy, during and thereafter and routine urinalysis and renal function tests are recommended. Progressive or sudden changes in renal function indicate the need for reevaluation of treatment. Monitoring lithium serum levels is also recommended.
Moderate:
galantamine
Galantamine has a moderate potential interaction with Renal Dysfunction.
In patients with creatinine clearance of 9 to 59 mL/min, the dosage of galantamine or benzgalantamine should generally not exceed 16 mg/day or 20 mg/day, respectively. In patients with creatinine clearance less than 9 mL/min, the use of galantamine or benzgalantamine is not recommended.
Seizures
Moderate:
galantamine
Galantamine has a moderate potential interaction with Seizures.
Cholinesterase inhibitors have been associated with convulsions and tremor. Therapy with cholinesterase inhibitors should be administered cautiously in patients with seizure disorders. Patients with Alzheimer's disease should be closely monitored for seizures.
Syncope
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Syncope.
Lithium should generally not be given to patients with significant cardiovascular disease since the risk of lithium toxicity is high in these patients. Additionally, there have been postmarketing reports of a possible association between lithium therapy and the unmasking of Brugada Syndrome, a disorder characterized by abnormal EKG findings and a risk of sudden death. Lithium should be avoided in patients with this diagnosis or suspicion of it, or that have risk factors, which include unexplained syncope, family history of this syndrome, or family history of unexplained sudden death before the age of 45 years.
Therapy with lithium should be administered with extreme caution in patients with preexisting cardiac disease. Consultation with a cardiologist is highly recommended and cardiac monitoring should be completed before and during treatment.
Tachyarrhythmia
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Tachyarrhythmia.
Lithium should generally not be given to patients with significant cardiovascular disease since the risk of lithium toxicity is high in these patients. Additionally, there have been postmarketing reports of a possible association between lithium therapy and the unmasking of Brugada Syndrome, a disorder characterized by abnormal EKG findings and a risk of sudden death. Lithium should be avoided in patients with this diagnosis or suspicion of it, or that have risk factors, which include unexplained syncope, family history of this syndrome, or family history of unexplained sudden death before the age of 45 years.
Therapy with lithium should be administered with extreme caution in patients with preexisting cardiac disease. Consultation with a cardiologist is highly recommended and cardiac monitoring should be completed before and during treatment.
Underactive Thyroid
Major:
Eskalith
The lithium in Eskalith has a major potential interaction with Underactive Thyroid.
The use of lithium has been associated with hypothyroidism in 5% to 15% of patient as it blocks the release of thyroxine (T4) and triiodothyronine (T3) mediated by thyrotropin. Therapy with lithium should be administered cautiously in patients with preexisting hypothyroidism. Careful monitoring of the thyroid function is recommended and supplemental thyroid treatment may be required.
More resources
Eskalith
A total of 750 drugs are known to interact with Eskalith.
- Eskalith is in the drug class antimanic agents.
- Eskalith is used to treat the following conditions:
galantamine
A total of 456 drugs are known to interact with galantamine.
- Galantamine is in the drug class cholinesterase inhibitors.
- Galantamine is used to treat Alzheimer's Disease.
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
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