Tacrine: a second look. An outdated drug to be discarded.

(1) Tacrine has been on the French market for four years for symptomatic treatment of Alzheimer's disease. (2) No new comparative efficacy data have been reported during this period. (3) A meta-analysis of available trials and a report by a Canadian expert group confirm our own conclusion: it is impossible to confirm that tacrine has any real clinical efficacy. (4) A French prospective safety study involving 5,000 patients shows that restricting tacrine to hospital-only prescription fails to guarantee that the Summary of Product Characteristics (SPC) is followed correctly. (5) The same study confirms the hepatotoxicity of tacrine: nearly half the patients who receive the drug have a rise in transaminase levels during treatment. (6) Two other preparations with the same indication, donepezil and rivastigmin, are now available. Their efficacy is no greater and no better documented than that of tacrine, but they have no known hepatotoxicity.