Before starting
Required
- Baseline
- Pulse
- Electrolytes
- Body weight
- Estimated glomerular filtration ratefor galantamine and rivastigmine only
- Liver function tests
Consider
- Baseline
- ECGmay be considered for some patients at particular risk of QTc prolongation. See SPS article Identifying risk factors for developing a long QT interval
LFTs and hepatic function: respond if abnormal
SPS have a series of articles on Assessing liver function and interpreting liver blood tests
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
Serum electrolytes: respond if abnormal
Donepezil
Caution in electrolyte disturbance, for example hypokalaemia or hypomagnesaemia
Galantamine
Caution in electrolyte disturbance, for example hyperkalaemia or hypokalaemia
Rivastigmine
Caution in electrolyte disturbance, for example hypokalaemia or hypomagnesaemia
After started or dose changed
Required
- Monthly
- Pulse
Ongoing once stable
Required
- 6 monthly
- Pulse
Ongoing once stable
Consider
- Periodically
- Body weight
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
- British National Formulary. Donepezil hydrochloride. Available at: https://bnf.nice.org.uk/drugs/donepezil-hydrochloride/ [cited 05/08/25]
- British National Formulary. Galantamine. Available at: https://bnf.nice.org.uk/drugs/galantamine/ [cited 05/08/25]
- British National Formulary. Rivastigmine. Available at: https://bnf.nice.org.uk/drugs/rivastigmine/ [cited 05/08/25]
- NICE Clinical Knowledge Summaries (CKS). Dementia. Updated May 2025. Available at: https://cks.nice.org.uk/topics/dementia/ [cited 05/08/25]
- Summary of Product Characteristics. Donepezil Hydrochloride 10mg film-coated tablets – Ranbaxy (UK) Limited a Sun Pharmaceutical Company. Updated 23/02/24. Available at: https://www.medicines.org.uk/emc/product/4427/smpc#gref [cited 06/08/25]
- Summary of Product Characteristics. Galantamine 8mg prolonged-release hard capsules – Krka UK Ltd. Updated 03/10/2023. Available at: https://www.medicines.org.uk/emc/product/15016/smpc [cited 06/08/25]
- Summary of Product Characteristics. Rivastigmine KRKA 3mg hard capsules – Krka UK Ltd. Updated 23/01/24. Available at: https://www.medicines.org.uk/emc/product/15415/smpc [cited 06/08/25]
- Rowland J P, Rigby J, Harper A C, Rowland R. Cardiovascular monitoring with acetylcholinesterase inhibitors: a clinical protocol. Advances in Psychiatric Treatment. Published 02/01/2018. Available at: https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/cardiovascular-monitoring-with-acetylcholinesterase-inhibitors-a-clinical-protocol/01FDD076C8F760789B687755CB009635 [Accessed 03/09/25]
- Taylor D M, Barnes T R E, Young A H. The Maudsley Prescribing Guidelines in Psychiatry. 14th edition.
Update history
- Republished
- Full update and review of monograph
- Published