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note: The manufacturer of tacrine is no longer aggressively marketing this drug.

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.

Approved by FDA for Alzheimer's use?: Yes

Pharmacological role: Acetylcholinesterase inhibitor

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.

Cost: ~$125/month

Selected References:

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, Schuck 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.

Gracon SI, Knapp MJ, Berghoff WG, Pierce M, DeJong R, Lobbestael SJ, Symons J, Dombey SL, Luscombe FA, Kraemer D. Safety of tacrine: clinical trials, treatment IND, and postmarketing experience. Alzheimer Dis Assoc Disord 12(2):93-101 (Jun 1998) Abstract.

Svensson AL, Nordberg A. Tacrine and donepezil attenuate the neurotoxic effect of A beta(25-35) in rat PC12 cells. Neuroreport 9(7):1519-1522 (May 1998) Abstract.

Riekkinen M, Soininen H, Riekkinen P Sr, Kuikka J, Laakso M, Helkala EL, Partanen J, Riekkinen P Jr. Tetrahydroaminoacridine improves the recency effect in Alzheimer's disease. Neuroscience 83(2):471-479 (Mar 1998) Abstract.

Lou G, Montgomery PR, Sitar DS. Bioavailability and pharmacokinetic disposition of tacrine in elderly patients with Alzheimer's disease. J Psychiatry Neurosci 21(5):334-339 (Nov 1996) Abstract.

Soares JC, Gershon S. THA--historical aspects, review of pharmacological properties and
therapeutic effects. Dementia 6(4):225-234 (Jul 1995) 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 271(13):985-991 (Apr 1994) Abstract.