Galantamine

Dual mechanism (AChE inhibition + nicotinic modulation) distinguishes it from donepezil. Similar modest efficacy for Alzheimer's symptoms. Also used off-label for lucid dreaming.

A rough internal score reflecting quantity, quality, and consistency of human evidence. Not a clinical recommendation.

Multiple large RCTs show significant improvement in cognition (ADAS-cog) and global function in mild-to-moderate AD. Dual mechanism may provide theoretical advantages but head-to-head superiority over donepezil is not established. Notable off-label popularity for enhancing lucid dreaming due to REM sleep modulation.

• Dual AChE inhibition and nicotinic receptor modulation
• FDA-approved for mild-to-moderate Alzheimer's
• Well-established efficacy from large clinical programs

Start 4 mg twice daily with meals. Increase to 8 mg twice daily after 4 weeks, then 12 mg twice daily. Extended-release: 8–24 mg once daily.

• Nausea
• Vomiting
• Diarrhea
• Decreased appetite
• Dizziness

Same cholinergic cautions as donepezil: bradycardia, GI effects, worsening of asthma/COPD. Hepatic impairment requires dose adjustment.

Symptomatic treatment only. No head-to-head superiority over other AChE inhibitors demonstrated.

• Memory55
• Focus40
• Sleep20