Reminyl

Reminyl®
Reminly® (galantamine) is the latest reversible cholinesterase inhibitor (2001), introduced by Janssen Pharmaceuticals in this category. 

The drug is a natural alkaloid originating from the bulbs of the common snowdrop flower; also know as the daffodil or Galanthus nivalis. 

It works both by inhibiting the enzyme that breaks down acetylcholine and by stimulating certain receptors in the brain to release more acetylcholine.

Compared to Aricept® and similar to Exelon®, Reminyl® requires multiple daily dosages and a slow dosage titration to limit GI side effects.

 Hepatotoxicity, however, has not been noted with Reminyl® as it has for Cognex®.  Overall, Reminyl® appears to be a viable first-line treatment option for Alzheimer\'s disease. 

The drug improves cognitive functioning as assessed by the ADAS-cog/11 and the CIBIC-plus scales.

 However, there are no head-to-head studies that compare Reminyl® with other cholinesterase inhibitors.

In other countries, where the drug is know as Novalin®, Reminyl® has been used off-label for other conditions, including glaucoma, muscular dystrophy, myasthenia gravis, and neuritis.

Exelon

Exelon®
Exelon® (rivastigmine) is the third cholinesterase inhibitor launched for the treatment of mild to moderate dementia of the Alzheimer\'s type.

Clinical efficacy of Exelon® is similar to that of Aricept® and Cognex®, based on the Clinical Global Impression of Change (CGIC) scale and Alzheimer\'s Disease Assessment Scale-Cognitive Subscale score (ADAS-cog), but its tolerability is worse than that of Aricept®.

One of the advantages that Exelon® has over other cholinesterase inhibitors is the lack of drug interactions with other compounds. 

Due to the fact that Exelon® has low protein-binding potential and is not metabolized by hepatic cytochrome P450 oxidative isoenzymes, its likelihood of interactions with other drugs is much lower.

Another advantage that Exelon® has over Aricept® is the availability of both capsule and oral solution formulation.  Both formulations of Exelon®, however, are required to be taken twice daily with food.