[For donepezil see separate monograph]
Issues for Surgery
Potential deterioration in cognitive function if omitted.
Interaction with neuromuscular blocking drugs (NMBDs) if continued (see Interaction(s) with Common Anaesthetic Agents).
Advice in the Perioperative period
Stop 24 hours before operation1.
Restart as soon as possible post-operatively1.
If recovering from gastrointestinal or bladder surgery seek specialist advice before restarting (see Further Information).
Interaction(s) with Common Anaesthetic Agents
Neuromuscular Blocking Drugs (NMBDs)
Galantamine and rivastigmine can increase the risk of bradycardia when used concomitantly with the following2: -
Interaction(s) with other Common Medicines used in the Perioperative Period
None2, 3, 4, 5, 6.
The manufacturers of galantamine advise there is no rebound effect after abrupt discontinuation of treatment in preparation of surgery6. The manufacturers of rivastigmine also advise that temporary discontinuation before surgery can be considered4, 5.
Gastrointestinal or Bladder Surgery
The manufacturer advises that due to its cholinergic action galantamine is not recommended in patients with gastrointestinal obstruction or urinary outflow obstruction or in patients recovering from gastrointestinal or bladder surgery as it may exacerbate or induce this obstruction2, 6, 7. The manufacturer is not able to provide any recommendations on when galantamine can safely be restarted in this situation7; seek advice from patient’s specialist and monitor patient closely for obstruction. Rivastigmine is also cautioned in urinary obstruction although no specific recommendations are made with respect to gastrointestinal or bladder surgery4, 5.
Patients with dementia are at increased risk of developing post-operative delirium. Avoiding medications with anticholinergic side-effects e.g. cyclizine can minimise this risk1.