Alzheimer Research Forum Overview of Cognex (tacrine)

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Name: Tacrine

Other Names: Cognex™

Therapy Types: pharmaceutical

Mechanisms: Acetylcholinesterase inhibitor

Development Status: approved in U.S.

FDA Phase: FDA approved

Primary Medical Role: Improve cognitive symptoms in early Alzheimer's disease.

Role in Alzheimer's Disease: Increase cognition in mild to moderately demented Alzheimer's disease.

Contraindications: Liver disease.

Side Effects: Liver toxicity in almost 50% of patients, requiring constant blood monitoring for all patients using the drug. This is generally the toxicity that most concerns and limits the use of Tacrine. Other, far less frequent side effects include nausea, vomiting, seizures, abdominal cramps, diarrhea, dizziness, and syncope.

Evidence pro its efficacy: Numerous short-term (<2yr) studies have supported the efficacy for Tacrine in both cognitive and non-cognitive behavioristic spheres of life. This effect appears in approximately one-third, or fewer, of patients. It may be best for patients with some Parkinsonian clinical features.

Evidence con its efficacy: The use of this drug over the long term has not been examined. Moreover, the percentage of responders is somewhat low, between 20 and 40 percent.

Dosage: Varies, 50-100 mg/d, with or without lecithin as adjunct.

Notes: See Medline Plus Drug Information: Tacrine [MedMaster] and Tacrine (Systemic) [USP DI].

References

Mansouri A, Haouzi D, Descatoire V, Demeilliers C, Sutton A, Vadrot N, Fromenty B, Feldmann G, Pessayre D, Berson A. Tacrine inhibits topoisomerases and DNA synthesis to cause mitochondrial DNA depletion and apoptosis in mouse liver. Hepatology. 2003 Sep ;38(3):715-25. Abstract

Bentué-Ferrer D, Tribut O, Polard E, Allain H. Clinically significant drug interactions with cholinesterase inhibitors: a guide for neurologists. CNS Drugs. 2003 ;17 (13):947-63. Abstract

Sjögren M, Hesse C, Basun H, Köl G, Thostrup H, Kilander L, Marcusson J, Edman A, Wallin A, Karlsson I, Troell M, Wachtmaister G, Ekdahl A, Olofsson H, Sandström A, Andreasen N, Minthon L, Blennow K. Tacrine and rate of progression in Alzheimer's disease--relation to ApoE allele genotype. J Neural Transm. 2001;108(4):451-8. Abstract

Wong WJ, Liu HC, Fuh JL, Wang SJ, Hsu LC, Wang PN, Sheng WY. A double-blind, placebo-controlled study of tacrine in Chinese patients with Alzheimer's disease. Dement Geriatr Cogn Disord. 1999 Jul-Aug;10(4):289-94. Abstract

Allain H, Schück S, Lebreton S, Strenge-Hesse A, Braun W, Gandon JM, Brissot P. Aminotransferase levels and silymarin in de novo tacrine-treated patients with Alzheimer's disease. Dement Geriatr Cogn Disord. 1999 May- Jun;10(3):181-5. Abstract

Knapp MJ, Knopman DS, Solomon PR, Pendlebury WW, Davis CS, Gracon SI. A 30-week randomized controlled trial of high- dose tacrine in patients with Alzheimer's disease. The Tacrine Study Group. JAMA. 1994 Apr 6;271(13):985-91. Abstract

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