Ganstigmine is an orally active, carbamate-based acetylcholinesterase (AChE) inhibitor developed for the treatment of Alzheimer's disease. It is a newer generation AChE than BChE inhibitor, derived from genserine, and has a long duration of action in vivo. Studies have shown it significantly prevented the progressive neuronal cell death due to growth factor deprivation and decreased neurodegeneration. Ganstigmine may be a suitable candidate for the treatment of cholinergic deficit in Alzheimer's disease because it was found to significantly increase basal extracellular concentrations of acetylcholine in rat prefrontal cortex, and does not affect the concentrations of serotonin, noradrenaline and levels of dopamine and metabolites. It is safe and well tolerated at 5–10 mg doses as the study conducted in Phase I randomized, double-blind, placebo-controlled clinical trial. It was dropped from phase II trials because of its adverse effects reported in some patients.