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Tacrine for Alzheimer's Disease: Therapeutic Considerations

Alzheimer's disease (AD) is a progressive, irreversible neurological disease that burdens both patient and family with emotional, financial, and social costs. Approximately four million people have been diagnosed as having AD. In 1991, 266,000 cases of AD were diagnosed. This number is expected to increase as our population ages. In the past numerous drugs have been studied and used clinically in an attempt to reverse or slow the memory impairment, confusion, and behavioral problems caused by AD. None have been found to be consistently effective. In November 1993 the first drug in the USA, tacrine (Cognex), was approved for the treatment of AD. This approval has not come without some controversy. A considerable debate still exists as to the efficacy of tacrine in AD. Approximately 45% of patients will have a substantial increase in their liver function tests (ALT). Patients require close monitoring, especially during the first 18 weeks of treatment. In addition to this, tacrine does appear to have a number of less serious, but bothersome side effects and possible drug-drug and drug-disease interactions. This article provides the pharmacist with practical information regarding the safe, most effective use of this interesting drug. Tacrine is the first drug approved for the treatment of AD, but almost certainly not the last.