Reduction of brain amyloid- (A) has been proposed as a therapeutic target for Alzheimer disease (AD), and microglial A phagocytosis is noted as an A clearance system in brains. Galantamine is an acetylcholinesterase inhibitor approved for symptomatic treatment of AD. Galantamine also acts as an allosterically potentiating ligand (APL) for nicotinic acetylcholine receptors (nAChRs). APL-binding site is located close to but distinct from that for acetylcholine on nAChRs, and FK1 antibody specifically binds to the APL-binding site without interfering with the acetylcholine-binding site. We found that in human AD brain, microglia accumulated on A deposits and expressed ␣7 nAChRs including the APL-binding site recognized with FK1 antibody. Treatment of rat microglia with galantamine significantly enhanced microglial A phagocytosis, and acetylcholine competitive antagonists as well as FK1 antibody inhibited the enhancement. Thus, the galantamineenhanced microglial A phagocytosis required the combined actions of an acetylcholine competitive agonist and the APL for nAChRs. Indeed, depletion of choline, an acetylcholinecompetitive ␣7 nAChR agonist, from the culture medium impeded the enhancement. Similarly, Ca 2؉ depletion or inhibition of the calmodulin-dependent pathways for the actin reorganization abolished the enhancement. These results suggest that galantamine sensitizes microglial ␣7 nAChRs to choline and induces Ca 2؉ influx into microglia. The Ca 2؉ -induced intracellular signaling cascades may then stimulate A phagocytosis through the actin reorganization. We further demonstrated that galantamine treatment facilitated A clearance in brains of rodent AD models. In conclusion, we propose a further advantage of galantamine in clinical AD treatment and microglial nAChRs as a new therapeutic target.