Narcissus and Daffodil

344 D. Brown
reasoned that the efficacy of these two drugs could not be explained on the basis of
their anticholinesterase activity alone, and suggested (but presented no evidence
for) a range of actions, including beneficial effects on blood vessel tissue and a
reduction of capillary permeability. Treatment, given twice daily, with an
optimum total daily dose of 250 mg, was well tolerated, and no patient had to
discontinue therapy because of side effects.
Mania and schizophrenia
Disturbances in the balance between neurotransmitters may be manipulated to
improve a lot of patients suffering from mania and schizophrenia where, complex
imbalances often occur. Snorrason and Stefansson (1991) have used this argument
to justify treating manic patients with galanthamine. There is minimal detail in
this report but galanthamine, 10 mg, three times a day, was observed to improve
symptoms rapidly when given to a 74 year old lady who was unresponsive to lithium
and where other agents were contraindicated because of neuroleptic malignant
syndrome. The patient’s condition deteriorated when galanthamine was
stopped. The authors referred to ten other patients where the drug was of benefit.
Galanthamine has been associated with a slow improvement in psychomotor function
deficits in 18 of 30 patients with schizophrenia over a 3- to 4-week period
(Vovin et al., 1991).
Raised intraocular pressure
One paper mentions experiments where, galanthamine reduced intraocular pressure
when applied in an eye drop formulation to rabbits (Agarawal and Gupta,
1990). The effect was slow and peaked at 2 hours. Physostigmine is an established
drug for the treatment of glaucoma and it is interesting that galanthamine might
also prove useful. There are no published trials of this use in man.
Chronic fatigue syndrome (CFS)
Several symptoms of CFS such as sleep disturbances, poor concentration and generalised
fatigue are similar to the side effects of anticholinergic drugs; these can be
reversed with physostigmine, a cholinesterase inhibitor similar to galanthamine.
The latter has been shown to shorten rapid eye movement (REM) latency, increase
REM density and reduce slow wave sleep, modify poor concentration, memory
disturbances and reverse behavioural changes seen in Alzheimer’s disease. In
addition, galanthamine can elevate plasma cortisol levels, whereas patients suffering
from glucocorticoid deficiency have similar symptoms to those with CFS.
These observations have prompted suggestions that galanthamine may be of use
in this syndrome. Thirty-three patients were enrolled in an 8-week, double-blind,
placebo-controlled study involving galanthamine (Snorrason, 1993). Patients in
the active group received total divided, daily doses of 10–50 mg. The following
symptoms were improved significantly in the galanthamine group: sleep disturbances,
fatigue, myalgia, anxiety, immediate and delayed recall; improvements in
cognition were also observed. Similar results were published three years later by
the same author (Snorrason et al., 1996), highlighting marked improvements in