Galanthamine in Alzheimer's disease : a new alternative to tacrine?

Galanthamine (galantamine), a tertiary alkaloid derived from the bulbs of the snowdrop and various Narcissus species, is a selective, centrally active and reversible inhibitor of acetylcholinesterase that is suitable for oral therapy. After a long period during which the investigational and clinical use of the drug was limited to anaesthesia and the treatment of peripheral paralysis syndromes in Eastern Europe, the molecule has now emerged as a promising lead substance for the treatment of cognitive decline in Alzheimer's disease.Galanthamine has similar therapeutic potential to tacrine, but has a significantly more favourable pharmacokinetic and toxicity profile. A chemical synthesis process on the required industrial scale of several tons per year has become available, removing a major obstacle to the development of the drug. Clinical trials published so far are, however, rather limited in terms of both design and patient number. The main reason for this is that there has been a lack of strong support for the drug within the pharmaceutical industry. However, the available data support the notion that this molecule, if properly developed, could be a peer for any second-generation cholinergic drug currently in clinical trials for the symptomatic treatment of Alzheimer's disease.