Introduction
Reminyl is the brand name for the drug galantamine hydrobromide. It is licensed for the treatment of mild to moderately severe Alzheimer's disease.
Reminyl is not claimed to be a cure for Alzheimer's disease. It treats only the symptoms and there is no evidence to show that it could halt or reverse the process of cell damage that causes Alzheimer's disease.
Who might benefit?
Reminyl is intended only for people with Alzheimer's disease, and not for people with other kinds of dementia. It is licensed only for people who are in the mild to moderately severe stages of the illness.
It is important to realise that unfortunately Reminyl will not help everyone who tries it.
Effects
The effect of the drug will vary for different people. Some will not notice an effect at all. Others may find that their condition improves, or that they stay the same when they would have expected to get gradually less able because of the progression of Alzheimer's disease.
For most who take it there will not be a dramatic improvement, but the drug may help to stop symptoms getting worse. Janssen-Cilag and Shire, who manufacture the drug, did studies looking at the drug’s effect on memory and understanding, behaviour and people’s ability to carry out daily living activities.
The results of the studies are averages, so some people did better and some worse than the average. It is not possible to tell whether the drug will have an effect for any particular person.
On one measure of understanding and memory, people with Alzheimer's disease without treatment normally score 5-11 points worse after a year. After a year on the high dose of Reminyl, the average score of people taking Reminyl had stayed the same, and about a third had improved by 4 points. However, it must be remembered that 15% of people taking the placebo (dummy pill) also improved by the same amount. (This is a common effect in clinical trials when people take a placebo.)
For those who took Reminyl, behavioural symptoms such as anxiety, hallucinations and wandering on average did not get worse over the course of a five month study. For some people these symptoms improved, while for those not taking the drug they got significantly worse.
For activities of daily living, on average, people taking Reminyl also remained the same over a year, whereas those not taking the drug got worse at activities like bathing, managing money and preparing food.
Reminyl has been tested in large-scale trials on about 3,000 people. These studies were placebo-controlled and double-blind for six months, which means that some people received Reminyl and others received a placebo (dummy) tablet. None of the patients knew whether they were getting the drug or the placebo. At the end of the six months, all patients who chose to could receive Reminyl for a further six-month study, where no-one was on placebo. The drug companies also have information from earlier studies about how people with Alzheimer's disease score on these tests when taking placebo treatment over a period of a year, and they used this information to make some of the comparisons.
How to get treatment
If you are interested in Reminyl, the first step is to talk to your doctor. It is important that you have a proper diagnosis and assessment to make sure that it is Alzheimer's disease and not another form of dementia, and that it is the mild to moderately severe stages of the illness. The GP (family doctor) should normally refer you to a specialist, such as a psychiatrist, old age psychiatrist, neurologist or geriatrician, for assessment. If the treatment is suitable for you, the specialist may prescribe it or refer you back to the GP for a prescription.
Whether or not you, or the person you care for, are suitable for drug treatment, the doctor can give you information on local services which may help to cope with the illness.
How is it taken?
It is recommended that people start with a low dose of 4mg twice a day for at least 4 weeks. Your doctor may than decide to build up your dose month by month to a total of between 8 and 12 mg twice a day. Reminyl comes in 4 mg, 8mg and 12mg tablets.
If you miss a dose, you can take it as soon as you remember. But if you don’t realise until it is time for your next dose, just take that as normal - don’t take two doses at once.
At first, the doctor will probably want to see you more often than before you were taking the drug, to see if there are any problems. There are no special tests recommended for people taking Reminyl.
Side Effects
The most likely side effects are nausea and vomiting. These are more common when someone begins to take Reminyl or when the dose is increased, but often settle down with time. If these or any other symptoms occur, tell the doctor at once. He or she may suggest you drink more liquids and may prescribe a medicine to stop you feeling sick.
Other side effects that some people may get include: abdominal pain, diarrhoea, indigestion, decreased appetite, weight loss, headache, dizziness, tiredness, sleepiness or sleeplessness and confusion, a runny or blocked nose, a urinary tract infection and falling. In very rare cases trembling, a slow heartbeat or fainting has occurred. Speak to your doctor about any side effects you have.
Reminyl can affect the ability to drive or operate machinery.
Not everyone gets side effects. It is not possible to tell who will have side effects and who will not.
Drug Interactions
Taking some medicines together can be harmful. It is important to tell your doctor and the chemist if you are taking any other drugs when you are prescribed Reminyl. Some of the people in the drug trials were on other drugs for various medical conditions, so the studies have tested whether Reminyl interacts with many common drugs; but not all combinations have been tested.
Some drugs, for example some for diarrhoea, Parkinson’s disease or asthma, act in the same way as Reminyl. It is important not to take these together, so be sure to check with your doctor if you are on treatments for these conditions, or taking drugs for certain heart disorders or high blood pressure (eg digoxin or beta-blockers).
Your doctor may prescribe a smaller dose of Reminyl if you are taking some drugs, such as certain antidepressants (eg paroxetine, fluoxetine or fluvoxamine), quinidine (used for heart rhythm problems), ketoconazole (an antifungal) or ritonavir (a treatment for HIV).
Other conditions
Reminyl should not be used by people who have severe liver or kidney disease or combined liver and kidney problems.
It should also not be taken by anyone who is allergic to its ingredients, including the drug itself and the other contents of the pills. In particular, the colouring E110 in the 12mg tablets can cause an allergic reaction, like asthma, in some people. This is more likely for anyone allergic to aspirin.
Some other illnesses might be affected by taking Reminyl. You should make sure the doctor knows of any previous or current illnesses, including:
- liver or kidney problems
- heart disorders
- stomach ulcer or duodenal ulcer
- acute abdominal pain
- epilepsy
- respiratory diseases that affect breathing (like asthma)
- a recent operation on the gut or bladder or difficulties in passing urine
- galactose intolerance, lactase deficiency or glucose-galactose malabsorption (Reminyl contains lactose)
You should also tell the doctor if you are pregnant, trying to get pregnant or breastfeeding.
Anaesthetics
Like other drugs of its type, Reminyl may interact with anaesthetics, so it should be stopped if you are to have an operation – ask your doctor when you should stop taking it.
Overdose
If too much Reminyl has been taken, contact a doctor or hospital straightaway. Take any remaining tablets and the packaging with you.
When to stop taking Reminyl
It is best to discuss with the doctor when to stop the drug. However, it is possible to stop immediately if you feel this is necessary. Talk to the doctor as soon as possible.
If it is not clear whether the drug is having an effect, your doctor may advise you to stop the drug for a few days to see if there is any change in your condition.
How it works
Acetylcholine is a brain chemical which carries messages between brain cells (a neurotransmitter). When someone has Alzheimer's disease, it seems that - among other changes - his or her brain produces less acetylcholine. Normally there is a repeated cycle in the brain in which acetylcholine is made, it transmits messages and it is then broken down by a special enzyme (acetylcholinesterase). All three drugs currently available for Alzheimer's disease aim to affect this cycle by preventing the breakdown of acetylcholine so that there is more available in the brain to carry messages between the brain cells. Reminyl also affects another part of the cycle causing greater release of the chemical.
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