ABSTRACT
We report our first 100 cases of Alzheimer's (AD) patients treated with tacrine (Cognex) for a period of one year. At the beginning of treatment the mean Mini-Mental-Status (MMS) score was 15.1. To date 71 patients are still under treatment (12 for more than 12 months). Forty-three instances of side-effects were observed, of which 31 involved hepatic side-effects with an increase in ALAT > IN (normal value) (6 cases > 3N), the mean date of appearance was 10.4 +/- 6.8 weeks, there were 16 cholinergic side-effects (nausea, vomiting, diarrhoea), plus 4 neurologic and 2 cutaneous side-effects. These side-effects led to the arrest of the treatment in 19 cases (16 for hepatic toxicity). Treatment was reattempted after interruption in 13 cases; successfully in 3 instances only. The measure of tacrine efficacy was based on 52 MMS score re-evaluations in week 18: there was an increase of the MMS score in 22 cases (3.3 points +/- 2.5), a stabilisation in 11 cases and a decrease in 19 cases (3.3 points +/- 2.2.). In week 30, the MMS scores (35 patients) increased in 9 cases (3.6 points +/- 2.4), stabilized in 5 cases and decreased in 21 cases (3.9 points +/- 3.3). At week 52, only 28 per cent of the patients were considered as either improved or stabilized. We conclude that there is a necessity for close follow-up of tacrine-treated patients, and that globally at 8 months there is an improvement or a stabilization in 40 per cent of patients and long term (at one year) a stabilizing effect on AD patients.
Subject(s)
Alzheimer Disease/drug therapy , Nootropic Agents/therapeutic use , Tacrine/therapeutic use , Aged , Aged, 80 and over , Alanine Transaminase/blood , Alzheimer Disease/psychology , Female , Follow-Up Studies , Humans , Liver/drug effects , Liver/pathology , Male , Mental Status Schedule , Middle Aged , Nootropic Agents/adverse effects , Tacrine/adverse effects , Time Factors , Treatment OutcomeABSTRACT
Amber-coloured syringes designed for the distribution of unit-doses of oral drops were studied for the efficiency of the photoprotectiveness and the possible binding of eleven phenothiazine neuroleptics: alimemazine, chlorpromazine, cyamemazine, fluphenazine, levomepromazine, periciazine, pipotiazine, prochlorperazine, thioproperazine, thioridazine, and trifluoperazine, all very easily oxidized in solution in daylight. Spectrofluorimetry made it possible, in one operation, to determine the remaining concentrations of drugs after storage and to verify the absence of photo-oxidation. The storage was performed up to 13 days at 25 +/- 3 degrees C and without any precaution from daylight. All the drugs studied were stable and none bound on the syringes. However, the stability appeared to be due to the antioxidants in the drug preparations, and not to the coloured material, since oral drops were also stable in uncoloured syringes designed for injection. Nevertheless, the amber-coloured syringes efficiently protect the active principles in pure aqueous solutions, without preservative, and thus this physical protection reinforces the chemical one of the galenical formulation.
