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Generic name/active ingredient(s): Tacrine
Trade name: Cognex
Manufacturer: Pfizer, Novartis
Dosage form(s): capsules
Additive ingredients: Tacrine hydrochloride
Role of each active ingredient: Tacrine improves the function of nerve cells
in the brain. It works by preventing the breakdown of a chemical called
acetylcholine
Uses: Treating mild to moderate dementia (e.g., impairment of memory or
judgement, abstract thinking, changes in personality) in patients with
Alzheimer disease.
Dose regimen: The recommended dosage is 19 to 20 mg four times daily,
OTC or Rx: By prescription only (RX)
Adverse effects:
stomach upset
shaking
agitation
skin rash
urinating more than usual
increased sweating
joint or muscle pain
nausea
indigestion
vomiting
diarrhea
abdominal pain
Serious side effects of Cognex include:
increases in a liver test called alanine aminotransferase (ALT)
as a result of liver damage.
Drug interactions:
Theophylline:
o Coadministration of tacrine with theophylline increased
theophylline elimination half-life and average plasma
theophylline concentrations by 2-folds Therefore,
monitoring of plasma theophylline concentrations and
appropriate reduction of theophylline dose are
recommended in patients receiving tacrine and
theophylline concurrently.
Cimetidine:
o Cimetidine increased the Cmax and AUC of tacrine by
approximately 54% and 64%, respectively.
Anticholinergics: Because of its mechanism of action, Cognex®
(tacrine) has the potential to interfere with the activity of
anticholinergic medications.
Cholinomimetics and Cholinesterase Inhibitors:
o A synergistic effect is expected when Cognex® (tacrine)
is given concurrently with succinylcholine cholinesterase
inhibitors, or cholinergic agonists such as bethanechol.
Fluvoxamine:
o In a study of 13 healthy, male volunteers, a single 40 mg
dose of tacrine added to fluvoxamine 100 mg/day
administered at steady-state was associated with five-
and eight-fold increases in tacrine Cmax and AUC,
respectively, compared to the administration of tacrine
alone. Five subjects experienced nausea, vomiting,
sweating, and diarrhea following coadministration,
consistent with the cholinergic effects of tacrine.
Other Interactions:
o Rate and extent of tacrine absorption were not
influenced by the coadministration of an antacid
containing magnesium and aluminium. Tacrine had no
major effect on digoxin or diazepam pharmacokinetics
or the anticoagulant activity of warfarin
Patient education:
Cognex may pass into breast milk and be harmful to the
nursing infant; it should not be used while breastfeeding.
Tacrine is best taken on an empty stomach (1 hour before or 2
hours after meals). However, if this medicine upsets your
stomach, your doctor may want you to take it with food.
Tacrine may cause some people to become dizzy, clumsy, or
unsteady. Make sure you know how you react to this medicine
before you do anything that could be dangerous if you are
dizzy, clumsy, or unsteady.
Before you have any kind of surgery, dental treatment, or
emergency treatment, tell the medical doctor or dentist in
charge that you are taking this medicine. Taking tacrine
together with medicines that are sometimes used during
surgery or dental or emergency treatments may increase the
effects of these medicines.
