Tacrine Disease Interactions

The use of cholinesterase inhibitors has been associated with a constriction of coronary arteries. Therapy with cholinesterase inhibitors should be administered cautiously in patients with coronary artery disease.

Cholinesterase inhibitors should be used with caution in patients with parkinsonism. Some of these drugs might be contraindicated in these patients (refer to specific prescribing information). Symptoms of Parkinson's disease may be exacerbated with the increase in cholinergic activity. Caregivers and patients should be advised.

The use of tacrine is contraindicated in patients with a history of tacrine-induced jaundice confirmed by elevated total bilirubin greater than 3.0 mg/dl. Elevations in liver function tests (LFTs) have been reported in as many as 50% of patients receiving tacrine. Twenty-five percent of patients may experience a 3 fold rise in ALT and 7% a 10 fold rise in ALT. LFTs should be monitored prior to initiation of tacrine therapy is initiated and when dosages are altered. Tacrine undergoes extensive first-pass metabolism by the liver (CYP450-1A2) to multiple forms. The metabolic and therapeutic activity of tacrine can be altered in patients with compromised hepatic function and therapy with tacrine should be administered cautiously in these patients.

Many of the manifestations of hyperthyroidism may be exacerbated by increased levels of acetylcholine produced by cholinesterase inhibitors. Therapy with cholinesterase inhibitors should be administered cautiously to patients with hyperthyroidism. Monitoring of thyroid levels is recommended.