A RISK-BENEFIT ASSESSMENT OF TACRINE IN THE TREATMENT OF ALZHEIMERS-DISEASE

Tacrine, the first drug specifically approved for Alzheimer's disease, produces symptomatic improvement. The theoretical rationale behind tr eating Alzheimer's disease with tacrine is based on central cholinergi c depletion. Tacrine is centrally acting, uncompetitive reversible inh ibitor of acetylcholinesterase and butyrylcholinesterase. Multiple cli nical trials support the effectiveness of tacrine in Alzheimer's disea se. High dosages of tacrine are required for efficacy, with the potent ial for hepatic and mild gastrointestinal adverse effects. However, th e benefits of tacrine currently outweigh its risks, and a trial of the drug should be offered to patients. As clinical experience with tacri ne increases, the long term risk-benefit equation may be refined.