Tacrine (Cognex)

Mechanism of Action: Presumably acts by elevating acetylcholine concentrations in the cerebral cortex by slowing the degradation of acetylcholine.

Therapeutic Use: Treatment of mild to moderate Alzheimer dementia (impaired intellectual functioning).

Absorption: Rapidly absorbed after oral administration. Maximal plasma concentration is reached in 1-2 hours.

Metabolism: Extensively metabolized by the cytochrome P-450 system to multiple metabolites, not all of which have been identified.

Half-life: 2-4 hours.

Average Daily Dose (adult): Initial dose is 40 mg/day (10 mg QID).

Adverse Effects: Abdominal cramps, nausea, vomiting and diarrhea. Elevation of liver enzymes. Bradycardia, dizziness, confusion, ataxia and insomnia.

Drug Interaction: Theophylline, Cimetidine, Anticholinergics, Cholinomimetics and Cholinesterase inhibitors.

Contraindication: Patients with known sensitivity to tacrine and patients with liver disease.

General References:

Masanic, C., Bayley, M., vanReekum, R. and Simard, M. (2001). Open-label study of Donepezil in traumatic brain injury. Archives of Physical Medicine and Rehabilitation. 82(7), 896-901.

León-Carrión, J. (2000). The role of citicholine in neuropsychological training after traumatic brain injury.Neurorehabilitation. 14(1), 33-40.

Showalter, P. and Kimmel, D. (2000). Stimulating consciousness and cognition following severe brain injury: a new potential clinical use for lamotrigine.Brain Injury. 14(11), 997-1002.

Whitlock, J. (1999). Brain injury, cognitive impairment, and donepezil. Journal of Head Trauma Rehabilitation. 14(4), 424-427.

McDowell, S. (1996). A role of dopamine in executive function deficits. Journal of Head Trauma Rehabilitation. 11(6), 89-92.

Eames, P. & Sutton, A. (1995). Protracted post-traumatic confusional state treated with physostigmine.Brain Injury. 9(7), 729.

Hock, F. (1995). Therapeutic approaches for memory impairments. Behavioral Pain Research. 66(1-2), 143-150.

Cardenas, D.D., McLean, Jr., A., Farrell-Roberts, L., et al. (1994). Oral physostigmine and impaired memory in adults with brain injury.Brain Injury. 8(7), 579-587.

Wroblewski, B.A. & Glenn, M.B. (1994). Pharmacological treatment of arousal and cognitive deficits.Journal of Head Trauma Rehabilitation. 9(3), 19.

Cardenas, D.D. (1993). Cognition-enhancing drugs.Journal of Head Trauma Rehabilitation. 8(4), 112-114.

McLean, Jr. A., Cardenas, D.D., Haselkorn, J.K., & Peters, M. (1993). Cognitive psychopharmacology.Neurorehabilitation. 3(2), 1-14.

McLean, Jr., A., Cardenas, D.D., Burgess, D. & Gamzu, E. (1991). Placebo-controlled study of pramiracetam in young males with memory and cognitive problems resulting from head injury and anoxia.Brain Injury. 5(4), 375-350.

McIntyre, F.L. & Gasquoine, P. (1990). Effect of clonidine on post-traumatic memory deficits.Brain Injury. 4(2), 209-211.

McLean, A., Stanton, K.M., Cardenas, D.D. & Bergerud, D.B. (1987). Memory training combined with the use of oral physostigmine.Brain Injury. 1(2), 145-159.

Weinberg, R.M., Auerbach, S.H. & Moore, S. (1987). Pharmacologic treatment of cognitive deficits: A case study.Brain Injury. 1(1), 57-59.

Cope, D.N. (1986). The pharmacology of attention and memory.Journal of Head Trauma Rehabilitation. 1(3), 34-42.