Acetylcholinesterase Inhibitors Galantamine, Donepezil, Rivastigmine (Efficacy)

Cholinesterase inhibitors are effective in the treatment of mild to moderate Alzheimer's disease. There is great variability in the response to these drugs, and part of this variability is attributed to the presence of genetic variants.

Cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine, are effective for mild to moderate Alzheimer's disease. Alzheimer's disease is the most frequent cause of dementia that affects older people and is associated with the loss of cholinergic neurons in certain regions of the brain. Cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine, delay the degradation of acetylcholine released in synaptic clefts and, thus, reinforce cholinergic neurotransmission.


Cautions should be taken when prescribing galantamine. Extend the precautions in patients with hepatic insufficiency, with abnormalities of the supraventricular conduction, in patients with congestive heart failure, in those patients who have suffered an acute myocardial infarction recently or have been diagnosed with atrial fibrillation and in patients with electrolyte alterations that have not been corrected. Caution should be exercised when galantamine is prescribed in patients taking digoxin or β-blockers at the same time. One must be very cautious if prescribing galantamine in patients with obstructive pulmonary diseases, severe asthma, pulmonary infections and cerebrovascular disease. Caution in anesthesia since galantamine increases muscle relaxation type succinylcholine. Galantamine is not recommended in children.

Cautions that should be taken when prescribing donepezil. Caution in anesthesia for increased muscle relaxation type succinylcholine. Precautions in patients with abnormal supraventricular cardiac conduction, patients with a history of asthma, with a history of obstructive pulmonary disease, or with a history of ulcerative disease. Precautions should be taken when prescribing donepezil in concomitance with NSAIDs (non-steroidal anti-inflammatory drugs) since may exacerbate or induce extrapyramidal symptoms. There is a risk of developing neuroleptic malignant syndrome during treatment with donepezil: if indicative symptoms develop stop treatment immediately. There is also a risk of rhabdomyolysis, more frequent at the beginning of treatment or when increasing the dose.


Potential adverse effects during galantamine treatment: Decreased appetite, hallucinations, depression, syncope, dizziness, tremor, headache, drowsiness, lethargy, bradycardia, high blood pressure, vomiting, nausea, abdominal pain, diarrhea, dyspepsia, muscle spasms, fatigue , asthenia, malaise, fever, headache, weight loss, falls and laceration.

Potential adverse effects during donepezil treatment: Diarrhea, muscle cramps, fatigue, pain, nausea, vomiting, insomnia, syncope, dizziness, abdominal discomfort, urinary incontinence, rash, pruritus, headache, anorexia, common cold, hallucinations, agitation, aggressive behavior, abnormal dreams, nightmares and accidents.


  • Galantamine: Galantamina®, Galnora®, Reminyl®
  • Donepezil: Aricept®
  • Rivastigmine: Exelon®, Prometax®

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