RAZADYNE ER Mechanism of Action

RAZADYNE ER: A competitive and reversible agent that enhances cholinergic function

RAZADYNE ER is in a class of drugs called acetylcholinesterase inhibitors (AChEIs). Taken once daily, the extended-release mechanism delivers galantamine over a 24-hour period. It is postulated that RAZADYNE ER may block an enzyme that breaks down acetylcholine (ACh) in the brain, thereby making more AChE available.^1,2 It is also postulated that RAZADYNE ER works on nicotinic receptors. ^1,2 The clinical significance of these mechanisms is unknown.

Samochocki M, Zerlin M, Jostock R, et al. Galantamine is an allosterically potentiating ligand of the human α4/β2 nAChR. Acta Neurol Scand. 2000;176(suppl):68-73.
Maelicke A, Albuquerque EX. Allosteric modulation of nicotinic acetylcholine receptors as a treatment strategy for Alzheimer's disease. Eur J Pharmacol. 2000;393:165-170.

IMPORTANT SAFETY INFORMATION

Most frequent adverse events
In clinical trials, the most frequent adverse events with RAZADYNE ER were similar to those seen with RAZADYNE.

The most frequent adverse events that occurred with RAZADYNE were nausea, vomiting, diarrhea, anorexia, and weight loss.

Anesthesia
Cholinesterase inhibitors, such as galantamine HBr, are likely to exaggerate the neuromuscular blocking effects of succinylcholine-type and similar neuromuscular blocking agents during anesthesia.

Cardiovascular events
Because of their pharmacological action, cholinesterase inhibitors have vagotonic effects on the sinoatrial and atrioventricular (AV) nodes, leading to bradycardia and AV block. These actions may be particularly important to patients with supraventricular cardiac conduction disorders or to patients taking other drugs concomitantly that significantly slow heart rate. In clinical trials, galantamine HBr was associated with more frequent reports of bradycardia and syncope vs placebo.

Gastrointestinal
Cholinesterase inhibitors may increase gastric acid secretion. Patients should be monitored closely for symptoms of active or occult gastrointestinal bleeding, especially those with an increased risk of developing ulcers, eg, those with a history of ulcer disease or patients using concurrent nonsteroidal anti-inflammatory drugs.

Genitourinary
Cholinesterase inhibitors may cause bladder outflow obstruction.

Neurological conditions
Cholinesterase inhibitors are believed to have some potential to cause generalized convulsions. In clinical trials, there was no increase in the incidence of convulsions with galantamine HBr compared with placebo.

Pulmonary conditions
Cholinesterase inhibitors should be prescribed with care to patients with a history of asthma or obstructive pulmonary disease.

Deaths in subjects with mild cognitive impairment (MCI)
In controlled trials in elderly subjects with MCI, 13 subjects on RAZADYNE (n=1026) and 1 subject on placebo (n=1022) died of various causes. About half of the RAZADYNE deaths appeared to result from various vascular causes (myocardial infarction, stroke, and sudden death). RAZADYNE and RAZADYNE ER are not indicated for the treatment of MCI.

Hepatic or renal impairment
In patients with moderately impaired hepatic or renal function, dose titration should proceed cautiously. The use of RAZADYNE or RAZADYNE ER in patients with severe hepatic impairment or severely impaired renal function
(Cl_cr <9 mL/min) is not recommended.

Please see full Prescribing Information.

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