Adult Dosing
Mild to moderate Alzheimer's dementia
- Start 10 mg PO qid x4 wks
Notes:- Following initiation of treatment after 4 wks monitor transaminase levels every other week
- On no significant transaminase elevations and the therapy is tolerated by patients increase dose by 10 mg PO qid q4 wks to a maximum 40 mg PO qid
- Max: 160 mg/day
See Supplemental Patient Information
- Exaggeration of succinylcholine type muscle relaxation may occur during anesthesia
- This drug may exhibit vagotonic effects on the sinoatrial and atrioventricular nodes possibly leading to bradycardia and/or heart block. Patients with conduction abnormalities, bradyarrhythmias, or a sick sinus syndrome are more susceptible but may also occur in patients without known preexisting cardiac disease
- Risk for developing ulcers increases due to increased gastric acid secretion. Closely monitor patients having history of ulcer disease or those receiving concurrent nonsteroidal anti-inflammatory drugs (NSAIDs) for symptoms of active or occult GI disease
- Nausea, vomiting, and loose stools may occur even at recommended doses
- Hepatic injury may occur even in patients without a prior history of liver disease
- On prompt withdrawal of this drug following detection of serum aminotransferase elevations clinically evident signs and symptoms of liver injury are rare
- Elevated bilirubin (5.3x ULN) and jaundice with transaminase levels (AST/SGOT) nearly 20x ULN have been reported
- On post marketing surveillance liver toxicity associated with jaundice, raised serum bilirubin, pyrexia, hepatitis and liver failure have been reported
- Frequently monitor LFTs during therapy
- Occurrence of hepatocellular necrosis and granulomatous have been reported
- Females are more prone for the incidence of elevated transaminase levels
- Repeat full monitoring sequence in the event that a patient suspends treatment with tacrine for >4 wks
- Immediately and permanently discontinue therapy and avoid re-challenging patients on confirmation of jaundice
- Carefully and frequently (weekly) monitor serum ALT/SGPT while considering rechallenging patients with ALT/SGPT elevations <10x ULN. Administer initial dose of 40 mg/day (10 mg QID) and weekly monitor ALT/SGPT levels for patients considered for rechallenged. Resume recommended dose-titration if the patient is tolerating the dosage with no unacceptable elevations in ALT/SGPT even after 6 weeks. Weekly monitor Alt/SGPT levels for a total of 16 wks after which decrease monitoring to monthly for 2 months and q3 months thereafter
- Liver biopsy is not recommended in cases of uncomplicated transaminase elevation
- Bladder outflow obstruction may occur
- Generalized convulsions and seizure activity may be induced by this drug. Abrupt discontinuation or large reduction in total daily dose (80 mg/day or more) may lead to worsening of cognitive function
- Possibility for development of serious WBC abnormalities exists
Cautions: Use cautiously in
- Hepatic impairment
- Cardiac conduction abnormalities
- Bradyarrhythmias
- History of GI bleed
- Concurrent NSAIDS
- Asthma
- Peptic ulcer disease
- Smoking habit changes
Supplemental Patient Information
- Inform caregivers about the adverse effects those occurring in close temporal association with the initiation of therapy or on increase in dose (e.g., nausea, vomiting, loose stools, diarrhea, etc and those with a delayed onset (e.g., rash, jaundice, changes in the color of stool
- Encourage patients and caregivers to inform the physician about the emergence of new events or any increase in the severity of existing adverse clinical events
Pregnancy Category:C
Breastfeeding: Safety unknown.
Pricing data from www.DrugStore.com in U.S.A.
- Cognex 20 MG CAPS [Bottle] (SHIONOGI PHARMA)
120 mg = $315.99
360 mg = $879.92 - Cognex 10 MG CAPS [Bottle] (SHIONOGI PHARMA)
120 mg = $315.99
360 mg = $893.99
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
