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Memory Supplement Labels Don’t Match What’s Inside the Bottle   

New study finds people taking galantamine may be getting a much lower (or higher) dosage than they think


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When it comes to dietary supplements, what’s on the label isn’t always what’s inside the bottle. New research shows that’s the case with galantamine, a plant extract that’s marketed by some companies as a memory booster. 

In the U.S., galantamine is also sold as a prescription medication for the treatment of Alzheimer’s disease symptoms. It’s not the only medication you can find as both a supplement and a prescription drug; others include potassium, niacin and vitamin D.

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In a new study, published Feb. 23 in the journal JAMA, researchers investigated the label accuracy of prescription galantamine, sold as a generic, and galantamine sold as a supplement. When examining 10 different brands of galantamine supplements — labeled as containing 4, 6, 8 or 12 mg of galantamine per serving — the researchers found that the actual quantity of galantamine ranged from less than 2 percent to 110 percent of the labeled quantity.

The quantity of galantamine in the prescription bottles, labeled as containing 4, 8 or 12 mg of galantamine per pill, was much closer to what was printed on the bottle, ranging from 97.5 percent to 104.2 percent of the labeled content. 

The findings have a few implications, especially for older adults, says internist Pieter Cohen, M.D., the lead author on the study and an associate professor of medicine at Harvard Medical School.

“If anyone [diagnosed with Alzheimer’s disease] thinks it’s going to be a bargain to buy their galantamine over the counter rather than getting a prescription version, it’s not going to work out well at all, because they’re not going to get an accurate amount of galantamine,” he says. “If your doctor prescribes galantamine, make sure you’re getting a prescription version of it.” 

How galantamine works

Galantamine (brand name Razadyne) is prescribed for some people with mild Alzheimer’s disease to slow the breakdown of a chemical that helps the brain work properly, known as acetylcholine. According to the Mayo Clinic, the loss of acetylcholine is one of the earliest changes that takes place in the brains of people with Alzheimer’s disease. Galantamine does not prevent or cure Alzheimer’s disease, and is different from the newly approved monoclonal antibody treatment Leqembi, which in clinical trials was able to slow the progression of the disease.

When it comes to over-the-counter availability, the researchers note that “the sale of inaccurately labeled galantamine supplements promoted for nonspecific memory and other cognitive problems is concerning.” For one, galantamine can cause side effects — including nausea, vomiting, diarrhea, dizziness, headache, and a difficulty falling or staying asleep — and it can interact with a number of medications, including some heart and heartburn medications.

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What’s more, there’s no proof that it can help improve thinking and memory skills in people who do not have an Alzheimer’s diagnosis, Cohen says. “It’s a very, very specific treatment for a certain stage of Alzheimer’s disease. It’s not useful for healthy people to prevent Alzheimer’s disease or improve the memory of a healthy person.”

Advice for supplement users 

In the U.S., dietary supplements are regulated differently than over-the-counter and prescription medications. For example, the FDA does not approve supplements for their safety and effectiveness before they are marketed, nor does the agency approve their claims or labeling before they hit the shelves.

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Supplement manufacturers “don’t have to follow these strict regulations in terms of quality control and making sure that each pill has exactly the same amount as [drug manufacturers] do with FDA-prescribed drugs,” says Douglas Scharre, M.D., director of the Division of Cognitive Neurology at the Ohio State University Wexner Medical Center.

A study from Cohen and colleagues published last year in JAMA found that the vast majority of melatonin gummy products analyzed for the study were inaccurately labeled. Twenty-two of 25 products tested contained different amounts of melatonin than what was declared on the label. The actual quantity ranged from 74 percent to 347 percent of the labeled amount. 

The Council for Responsible Nutrition, a trade association representing the supplement industry, issued a statement in response to the JAMA galantamine study, saying that over-the-counter products containing galantamine are not legitimate dietary supplements. The group called for their removal from the market to protect consumers.

Cohen’s advice for consumers: Be wary of any claims printed on a bottle. In the case of products being sold that contain galantamine, he says, “there’s nothing I know of that’s legally sold as a dietary supplement that will improve memory in healthy people or in people who are starting to notice a subtle decline.”  

Accumulating research does show, however, that certain lifestyle behaviors can help to improve brain health and may lower your risk for dementia. For example, managing high blood pressure, avoiding smoking and staying physically active can be beneficial for the brain, according to the Centers for Disease Control and Prevention. Taking a daily multivitamin may also help, though research into its effectiveness is still ongoing, and experts stress that a healthy diet is really the key.

If you are going to buy a dietary supplement, Cohen says to look for one that has been certified by a third party, like USP (U.S. Pharmacopeia) or NSF International. These groups verify the quality of dietary supplements, so consumers know that what’s on the bottle is in the actual pill or powder. Also, talk to your doctor or pharmacist before taking a supplement to help avoid any medication interactions or adverse effects, the FDA says.

Finally, if you have concerns about your memory, talk to your doctor, who can help pinpoint the root of the problem, Scharre says. An accurate diagnosis may lead to finding medications that “are useful as opposed to not useful for you,” he says.

Editor's note: This story, first published Feb. 26, 2024, has been updated to include new information. 

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