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Limited coverage drugs – galantamine

Last updated on October 6, 2022

Generic name

galantamine                                                                                                                                               
Strength

8 mg, 16 mg, 24 mg

Form

extended release capsule

Special Authority criteria

Approval period

For the treatment of mild to moderate Alzheimer’s disease, Alzheimer’s disease with a vascular component, Alzheimer’s disease with Parkinsonian features (Lewy bodies), or mixed dementia with Alzheimer’s disease, in patients with:

AND

AND

  • An intolerance to donepezil.

Initial: 6 months

Renewal: 1 year

Practitioner exemptions

  • None

Special notes

  • Coverage is not available for patients switching from one cholinesterase inhibitor to another due to ineffectiveness (clinical failure), because there is insufficient evidence that switching to a different cholinesterase inhibitor will provide a better therapeutic effect.
  • Patients must be assessed on a regular basis (every 6 months) to ensure continued therapeutic benefit.

Special Authority request form(s)