Galantamine as a Potential Treatment for Peripheral Nerve Injuries: Emphasis on Non-Systemic Delivery

Galantamine, a reversible inhibitor of acetylcholinesterase, exhibits both acetylcholinesterase-inhibiting and neuroprotective properties. The FDA (Food and Drug Administration) and EMA ( European Medicines Agency) have approved it for use in the treatment of Alzheimer's disease dementia (AD). The side effects associated with oral administration include gastrointestinal irritation, first-pass hepatic metabolism leading to reduced bioavailability and systemic adverse reactions such as nausea or liver enzyme elevation. These issues have led to the exploration of alternative delivery routes, such as transdermal, intranasal, or buccal. Such routes can bypass the gastrointestinal tract and liver, thereby reducing the risk of digestive discomfort and hepatic strain. The FDA has approved acetylcholinesterase inhibitors, such as rivastigmine, for transdermal administration in the form of patches. Studies on the transdermal administration of galantamine are ongoing. In addition to its use for AD, galantamine is increasingly being investigated for its effects on various conditions, including its potential in treating peripheral nervous system damage. In Bulgaria, a method for depositing galantamine through iontophoresis has been developed and widely used in clinical practice for many years. However, there is a lack of scientific evidence to support its effectiveness according to modern scientific approaches, necessitating further research in this direction.