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Limited coverage criteria – galantamine

Last updated on March 18, 2025

 

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Generic name

galantamine

Strength & form

8 mg, 16 mg, 24 mg 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 for first renewal
  • indefinite coverage on second renewal

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)