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Medicines Monitoring

Acetylcholinesterase inhibitors monitoring

Published
Topics: DonepezilGalantamineMonitoringRivastigmine
Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Contents
  1. Before starting
    1. Required
  2. Ongoing once stable
    1. Consider
  3. Notes
    1. Advice to patients for galantamine
  4. Bibliography

Before starting

Required

  • Baseline
    • Estimated glomerular filtration ratefor galantamine and rivastigmine only
    • Liver function tests
    • Serum potassiumfor galantamine

LFTs and hepatic function: respond if abnormal

Donepezil

Caution in mild to moderate impairment.
Adjust dose as per BNF advice.

Galantamine

Caution in moderate impairment; avoid in severe impairment (Child-Pugh score greater than 9).
Adjust dose as per BNF advice.

Rivastigmine

Caution in hepatic impairment.
Adjust dose as per BNF advice.

Renal function: respond if abnormal

Galantamine

Avoid if eGFR less than 9 mL/minute/1.73 m2

Rivastigmine

Caution in renal impairment

Potassium: respond if abnormal

Galantamine

Caution in hyperkalaemia or hypokalaemia

Ongoing once stable

Consider

  • Periodically
    • Weightfor rivastigmine and galantamine, since decreased appetite possible

Notes

Advice to patients for galantamine

Advise patients and their carers to be aware of the potential for serious skin reactions related to galantamine. These include Stevens-Johnson syndrome, erythema multiforme, and acute generalized exanthematous pustulosis.
Advise patients to report any skin rash. Stop galantamine at the first appearance of any skin rash.

Bibliography

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