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codeine and phenylephrine

Generic Name: codeine and phenylephrine (KOE deen and FEN il EFF rin)

Brand Names: Ala-Hist AC, Notuss-PE

What is codeine and phenylephrine?

Codeine is a narcotic cough suppressant.

Phenylephrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose).

The combination of codeine and phenylephrine is used to treat cough and nasal congestion caused by the common cold.

Codeine will not treat a cough that is caused by smoking, asthma, or emphysema.

Codeine and phenylephrine may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about codeine and phenylephrine?

Do not use this medication if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take a cough and cold medicine before the MAO inhibitor has cleared from your body.

You should not use codeine and phenylephrine if you are allergic to it, or if you have severe or uncontrolled high blood pressure, severe coronary artery disease, ischemic heart disease (reduced circulation of blood to the heart), or if you are breast-feeding a baby.

Before taking this medication, tell your doctor if you have heart disease or high blood pressure, asthma or other breathing disorder, diabetes, a thyroid disorder, an enlarged prostate, or problems with urination.

Always ask a doctor before giving cough or cold medicine to a child. Death can occur from the misuse of cough or cold medicine in very young children. Codeine and phenylephrine should not be given to a child younger than 6 years old.

What should I discuss with my healthcare provider before taking codeine and phenylephrine?

severe or uncontrolled high blood pressure;

severe coronary artery disease;

ischemic heart disease (reduced circulation of blood to the heart); or

if you are breast-feeding a baby.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely take codeine and phenylephrine:

heart disease or high blood pressure;

asthma, COPD, emphysema, or other breathing disorder;

diabetes;

a thyroid disorder; or

enlarged prostate, urination problems.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Codeine can cause breathing problems or addiction/withdrawal symptoms in a newborn. Tell your doctor if you are pregnant or plan to become pregnant while you are taking this medication. This medication can pass into breast milk and may harm a nursing baby. The use of codeine by some nursing mothers may lead to life-threatening side effects in the baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Codeine may be habit-forming and should be used only by the person it was prescribed for. This medication should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

How should I take codeine and phenylephrine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. Cold medicine is usually taken for only a short time until your symptoms clear up.

Measure liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Talk with your doctor if your symptoms do not improve after 7 days of treatment, or if you have a fever with a headache or skin rash. Store codeine and phenylephrine at room temperature away from moisture and heat.

Keep track of how much of this medicine has been used from the bottle. Codeine is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

See also: Codeine and phenylephrine dosage (in more detail)

What happens if I miss a dose?

Since cough and cold medicine is usually taken only as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include feeling restless or nervous, dizziness, fast or uneven heart rate, fainting, or seizure (convulsions).

What should I avoid while taking codeine and phenylephrine?

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol while you are taking this medication. Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Phenylephrine is contained in many medicines available over the counter. If you take certain products together you may accidentally take too much of this drug. Read the label of any other medicine you are using to see if it contains phenylephrine.

Codeine and phenylephrine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects:

fast or pounding heartbeat;

feeling like you might pass out;

chest tightness or congestion;

easy bruising or bleeding, unusual weakness;

severe dizziness, anxiety, restless feeling, or nervousness;

seizure (convulsions); or

painful or difficult urination.

Less serious side effects may include:

dizziness, drowsiness, headache;

dry mouth, nose, or throat;

nausea, vomiting, diarrhea, constipation;

increased sweating or urination;

feeling excited or restless;

sleep problems (insomnia);

blurred vision, dry eyes;

ringing in your ears; or

mild skin rash or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Codeine and phenylephrine Dosing Information

Usual Adult Dose for Cough and Nasal Congestion:

Codeine-phenylephrine 10 mg-7.5 mg/5 mL oral liquid:
5 mL orally every 4 to 6 hours not to exceed 30 mL daily.

Codeine-phenylephrine 10 mg-10 mg/5 mL oral liquid:
5 mL orally every 4 hours not to exceed 30 mL daily.

Usual Pediatric Dose for Cough and Nasal Congestion:

Codeine-phenylephrine 10 mg-7.5 mg/5 mL oral liquid:
6 to 11 years: 2.5 mL orally every 4 to 6 hours not to exceed 15 mL daily.
12 years or older: 5 mL orally every 4 to 6 hours not to exceed 30 mL daily.

Codeine-phenylephrine 10 mg-10 mg/5 mL oral liquid:
6 to 11 years: 2.5 mL orally every 4 hours not to exceed 15 mL daily.
12 years or older: 5 mL orally every 4 hours not to exceed 30 mL daily.

What other drugs will affect codeine and phenylephrine?

Tell your doctor if you regularly use other medicines that make you sleepy (such as pain medication, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by codeine and phenylephrine.

Tell your doctor about all other medicines you use, especially:

medicines to treat high blood pressure;

a beta-blocker such as atenolol (Tenormin), carteolol (Cartrol), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), timolol (Blocadren), and others; or

an antidepressant such as amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Janimine, Tofranil), and others.

This list is not complete and there may be other drugs that can interact with codeine and phenylephrine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

More codeine and phenylephrine resources

Codeine and phenylephrine Dosage
Codeine and phenylephrine Use in Pregnancy & Breastfeeding
Codeine and phenylephrine Drug Interactions
Codeine and phenylephrine Support Group
0 Reviews for Codeine and phenylephrine - Add your own review/rating

Compare codeine and phenylephrine with other medications

Cold Symptoms
Cough and Nasal Congestion

Where can I get more information?

Your pharmacist can provide more information about codeine and phenylephrine.

codeine and promethazine

Generic Name: codeine and promethazine (KOE deen and proe METH a zeen)

Brand names: Codeine Phosphate-Promethazine HCl, Promethazine HCl and Codeine Phosphate, Promethazine with Codeine, Phenergan with Codeine, Promethazine HCl with Codeine

What is codeine and promethazine?

Codeine is a narcotic. It is a pain reliever and a cough suppressant.

Promethazine is an antihistamine. It blocks the effects of the naturally occurring chemical histamine in your body.

The combination of codeine and promethazine is used to treat cold or allergy symptoms such as runny nose, sneezing, and cough.

Codeine and promethazine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about codeine and promethazine?

Tell your doctor about all of your medical conditions before you start taking this medication.

You should not use this medication if you are allergic to codeine or promethazine, or if you have asthma or other lung disease.

Codeine and promethazine may be habit-forming and should be used only by the person it was prescribed for. Keep the medication in a secure place where others cannot get to it. Do not give this medication to a child without medical advice. There are many other medicines that can cause interact with promethazine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

What should I discuss with my doctor before taking codeine and promethazine?

You should not use this medication if you are allergic to codeine or promethazine, or if you have high blood pressure, a blood vessel disorder, or asthma. Do not give this medication to a child without medical advice. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children.

To make sure you can safely take codeine and promethazine, tell your doctor if you have any of these other conditions:

epilepsy or other seizure disorder;

asthma, COPD, sleep apnea, or other breathing disorders;

glaucoma;

a stomach ulcer or digestive obstruction;

a weak immune system;

Addison's disease;

enlarged prostate, urination problems;

high or low blood pressure or heart disease;

liver or kidney disease;

underactive thyroid;

gallbladder disease; or

a head injury or brain tumor.

Codeine and promethazine may be habit forming and should be used only by the person it was prescribed for. Never share codeine and promethazine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. FDA pregnancy category C. It is not known whether codeine and promethazine will harm an unborn baby. Codeine and promethazine may cause addiction or withdrawal symptoms in a newborn if the mother takes the medication during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant while using codeine and promethazine. Codeine can pass into breast milk and may harm a nursing baby. The use of codeine by some nursing mothers may lead to life-threatening side effects in the baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take codeine and promethazine?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Measure liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Contact your doctor if your symptoms do not improve within a few days of using codeine and promethazine.

Store at room temperature away from moisture, heat, and light. Keep track of the amount of medicine used from each new bottle. Codeine and promethazine is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

See also: Codeine and promethazine dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of this medication may be fatal.

Overdose symptoms include dizziness, extreme drowsiness, dry mouth, nausea, vomiting, cold and clammy skin, weak pulse, shallow breathing, fainting, seizure (convulsions), or breathing that stops.

What should I avoid while taking codeine and promethazine?

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Drinking alcohol can increase certain side effects of codeine and promethazine. Avoid exposure to sunlight or tanning beds. Codeine and promethazine can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Codeine and promethazine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

restless muscle movements in your eyes, tongue, jaw, or neck, tremor (uncontrolled shaking);

shallow breathing, slow heartbeat;

feeling like you might pass out;

jaundice (yellowing of the skin or eyes);

confusion, agitation, hallucinations, unusual thoughts or behavior;

seizure (convulsions);

urinating less than usual or not at all; or

very stiff (rigid) muscles, high fever, sweating, fast or uneven heartbeats, fainting.

Less serious side effects may include:

dizziness, drowsiness, sleepiness;

feeling restless, nervous, or anxious;

blurred vision, ringing in your ears;

constipation, mild nausea or vomiting;

warmth, redness, or tingly feeling under your skin;

sleep problems (insomnia);

increased sweating;

dry mouth; or

mild skin rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Codeine and promethazine Dosing Information

Usual Adult Dose for Cough:

10 mg-6.25 mg/5 mL:
5 mL orally every 4 to 6 hours as needed. Maximum dose is 30 mL /24 hours.

Usual Pediatric Dose for Cough:

10 mg-6.25 mg/5 mL:
6 years to 12 years:
2.5 mL to 5 mL orally every 4 to 6 hours as needed. Maximum dose is 30 mL /24 hours.

12 years or older:
5 mL orally every 4 to 6 hours as needed. Maximum dose is 30 mL /24 hours.

What other drugs will affect codeine and promethazine?

Tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, other pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by codeine and promethazine.

Many drugs can interact with codeine and promethazine. Below is just a partial list. Tell your doctor if you are using:

sedatives or anxiety medicines such as alprazolam (Xanax), diazepam (Valium), chlordiazepoxide (Librium), temazepam (Restoril), or triazolam (Halcion);

antidepressants such as amitriptyline (Elavil, Vanatrip, Limbitrol), doxepin (Sinequan), nortriptyline (Pamelor), fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil);

narcotic pain medicines such as meperidine (Demerol), morphine (MS Contin, MSIR), propoxyphene (Darvon, Darvocet), hydrocodone (Lortab, Vicodin), oxycodone (Percocet, Percodan), fentanyl (Duragesic), codeine (Fiorinal, Fioricet, Tylenol #3);

phenobarbital (Luminal), amobarbital (Amytal) or secobarbital (Seconal);

an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate); or

atropine (Donnatal, and others), belladonna, clidinium (Quarzan), dicyclomine (Bentyl), glycopyrrolate (Robinul), hyoscyamine (Anaspaz, Cystospaz, Levsin, and others), methscopolamine (Pamine), and scopolamine (Transderm-Scop).

This list is not complete and other drugs may interact with codeine and promethazine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More codeine and promethazine resources

Codeine and promethazine Dosage
Codeine and promethazine Use in Pregnancy & Breastfeeding
Codeine and promethazine Drug Interactions
Codeine and promethazine Support Group
8 Reviews for Codeine and promethazine - Add your own review/rating

Compare codeine and promethazine with other medications

Cough

Where can I get more information?

Your pharmacist can provide more information about codeine and promethazine.

Codeine Phosphate Soluble Tablets

Pronunciation: KOE-deen FOS-fate
Generic Name: Codeine Phosphate
Brand Name: Generic only. No brands available.

Codeine Phosphate Soluble Tablets are used for:

Treating mild to moderate pain.

Codeine Phosphate Soluble Tablets are a narcotic analgesic. It works in certain areas of the brain and nervous system to decrease pain.

Do NOT use Codeine Phosphate Soluble Tablets if:

you are allergic to any ingredient in Codeine Phosphate Soluble Tablets or to any codeine- or morphine-related medicine (eg, oxycodone)

you are taking sodium oxybate (GHB)

Contact your doctor or health care provider right away if any of these apply to you.

Before using Codeine Phosphate Soluble Tablets:

Some medical conditions may interact with Codeine Phosphate Soluble Tablets. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding

if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

if you have allergies to medicines, foods, or other substances

if you have or recently have had any head injury, brain injury or tumor, increased pressure in the brain, infection of the brain or nervous system, epilepsy, or seizures

if you have a history of heart problems, stomach problems, bowel problems (eg, chronic inflammation or ulceration of the bowel), gallbladder problems (eg, gallstones), an enlarged prostate gland or other prostate problems, a blockage of your bladder or bowel, recent abdominal surgery, kidney or liver problems, adrenal gland problems (eg, Addison disease), or an underactive thyroid

if you have a history of asthma, chronic cough, lung problems (eg, chronic bronchitis, emphysema), or chronic obstructive pulmonary disease (COPD), or if your cough occurs with large amounts of mucus

if you have a history of alcohol abuse, drug abuse, or suicidal thoughts or behavior

Some MEDICINES MAY INTERACT with Codeine Phosphate Soluble Tablets. Tell your health care provider if you are taking any other medicines, especially any of the following:

HIV protease inhibitors (eg, ritonavir), monoamine oxidase (MAO) inhibitors (eg, phenelzine), other narcotic pain medicines, phenothiazines (eg, chlorpromazine), or tricyclic antidepressants (eg, amitriptyline) because side effects of Codeine Phosphate Soluble Tablets may be increased

Cimetidine or sodium oxybate (GHB) because the risk of severe drowsiness, breathing problems, and seizures may be increased

Naltrexone or quinidine because effectiveness of Codeine Phosphate Soluble Tablets may be decreased

This may not be a complete list of all interactions that may occur. Ask your health care provider if Codeine Phosphate Soluble Tablets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Codeine Phosphate Soluble Tablets:

Use Codeine Phosphate Soluble Tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Codeine Phosphate Soluble Tablets must be dissolved in sterile water and filtered through a 0.22 micron filter before use. It is usually administered as an injection at your doctor's office, hospital, or clinic. If you are using Codeine Phosphate Soluble Tablets at home, carefully follow the injection procedures taught to you by your health care provider.

If Codeine Phosphate Soluble Tablets contains particles or is discolored after mixing, do not use it.

Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor or pharmacist to explain local regulations for proper disposal.

If you miss a dose of Codeine Phosphate Soluble Tablets, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Codeine Phosphate Soluble Tablets.

Important safety information:

Codeine Phosphate Soluble Tablets may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Codeine Phosphate Soluble Tablets. Using Codeine Phosphate Soluble Tablets alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.

Avoid drinking alcohol or taking other medications that cause drowsiness (eg, sedatives, tranquilizers) while taking Codeine Phosphate Soluble Tablets. Codeine Phosphate Soluble Tablets will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants.

Some of these products contain sulfites, which can cause allergic reactions in certain individuals (eg, asthma patients). If you have previously had allergic reactions to sulfites, contact your pharmacist to determine if the product you are taking contains sulfites.

Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using Codeine Phosphate Soluble Tablets.

Use Codeine Phosphate Soluble Tablets with caution in the ELDERLY because they may be more sensitive to its effects.

PREGNANCY and BREAST-FEEDING: It is unknown if Codeine Phosphate Soluble Tablets can cause harm to the fetus. If you think you may be pregnant, discuss with your doctor the benefits and risks of using Codeine Phosphate Soluble Tablets during pregnancy. Codeine Phosphate Soluble Tablets are excreted in breast milk. Do not breast-feed while taking Codeine Phosphate Soluble Tablets.

When used for long periods of time or at high doses, Codeine Phosphate Soluble Tablets may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Codeine Phosphate Soluble Tablets stops working well. Do not take more than prescribed.

When used for long periods of time or at high doses, some people develop a need to continue taking Codeine Phosphate Soluble Tablets. This is known as DEPENDENCE or addiction.

If you suddenly stop taking Codeine Phosphate Soluble Tablets, you may experience WITHDRAWAL symptoms including anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; pain; rapid heartbeat; rigid muscles; seeing, hearing, or feeling things that are not there; shivering or tremors; sweating; trouble sleeping; and vomiting.

Possible side effects of Codeine Phosphate Soluble Tablets:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; dizziness; drowsiness; flushing; lightheadedness; nausea; sweating; tiredness; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); confusion; fast heartbeat; fainting; mental or mood changes; seizures; severe drowsiness or dizziness; slow or shallow breathing; trouble urinating.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Codeine Phosphate side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center ( http://www.aapcc.org), or emergency room immediately. Symptoms may include cold and clammy skin; coma; confusion; dizziness; excitability; fever; garbled speech; hallucinations; loss of consciousness; mood or mental changes; nausea; rapid breathing; restlessness; ringing in the ears or trouble hearing; seizures; skin rash; slow or shallow breathing; sluggishness; small pupils; sweating; thirst; unusual sleepiness; vision changes; vomiting.

Proper storage of Codeine Phosphate Soluble Tablets:

Codeine Phosphate Soluble Tablets are usually handled and stored by a health care provider. If you are using Codeine Phosphate Soluble Tablets at home, store Codeine Phosphate Soluble Tablets as directed by your pharmacist or health care provider.

General information:

If you have any questions about Codeine Phosphate Soluble Tablets, please talk with your doctor, pharmacist, or other health care provider.

Codeine Phosphate Soluble Tablets are to be used only by the patient for whom it is prescribed. Do not share it with other people.

If your symptoms do not improve or if they become worse, check with your doctor.

Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Codeine Phosphate Soluble Tablets. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

More Codeine Phosphate resources

Codeine Phosphate Side Effects (in more detail)
Codeine Phosphate Use in Pregnancy & Breastfeeding
Drug Images
Codeine Phosphate Drug Interactions
Codeine Phosphate Support Group
19 Reviews for Codeine Phosphate - Add your own review/rating

Compare Codeine Phosphate with other medications

Cough
Diarrhea
Pain

Carbaglu

Generic Name: carglumic acid (kar GLOO mik AS id)

Brand Names: Carbaglu

What is carglumic acid?

Carglumic acid is a man-made form of an enzyme that occurs naturally in the liver. This enzyme is necessary for processing excess nitrogen produced when the body metabolizes proteins. Without this enzyme, nitrogen builds up in the form of ammonia and is not removed from the body. Ammonia is very toxic when it circulates in blood and tissues and can cause permanent brain damage, coma, or death.

Carglumic acid is used to treat hyperammonemia (HYE-per-AM-moe-NEE-mee-a), a urea cycle disorder caused by lack of a certain liver enzyme. Carglumic acid is usually given with other medications to treat this lifelong disorder.

Carglumic acid may also be used for purposes not listed in this medication guide.

What is the most important information I should know about carglumic acid?

Avoid eating foods that are high in protein when you first start taking carglumic acid. Follow your doctor's instructions about any other restrictions on food, beverages, or activity.

Your doctor may occasionally change your dose to make sure you get the best results. Dose adjustments are especially important as your child grows.

If you skip a meal, do not take your dose of carglumic acid. Wait until your next meal.

What should I discuss with my healthcare provider before taking carglumic acid?

Tell your doctor about all of your medical conditions.

Carglumic acid is only part of a complete program of treatment that may also include a special diet and other medications. It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you should eat or avoid to help control your condition. FDA pregnancy category C. It is not known whether carglumic acid will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether carglumic acid passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using carglumic acid.

How should I take carglumic acid?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results. Dose adjustments are especially important as your child grows.

Carglumic acid is usually taken 2 to 4 times each day, just before each meal or feeding. Follow your doctor's instructions.

Do not chew, crush, or swallow the carglumic acid tablet whole. Place it into a glass of water and allow the tablet to disperse in the liquid. The tablet will not dissolve completely. Drink this mixture right away. To make sure you get the entire dose, add a little more liquid to the same glass, swirl gently and drink right away.

The carglumic acid tablet may be taken with an oral syringe as follows: Place a 200-milligram tablet into an oral syringe and draw 2.5 milliliters of water into the syringe. Shake until the tablet is dispersed and then empty the syringe into your mouth. Refill the syringe with water, shake gently, and empty into your mouth.

The carglumic acid tablet can also be given through a nasogastric (NG) feeding tube as follows: Disperse the tablet in an oral syringe as directed above. Attach the syringe to the NG tube and push the plunger down to empty the syringe into the tube. Then flush the tube with more water to wash the contents down.

To be sure this medicine is helping your condition and is not causing harmful effects, your blood will need to be tested often. A buildup of ammonia in the blood can quickly cause brain injury or death. Do not miss any follow up visits to your doctor for blood tests. Every person with a urea cycle disorder should remain under the care of a doctor. Store unopened bottles of carglumic acid tablets in the refrigerator, do not freeze. After opening the bottle, store at room temperature away from moisture and heat. Do not store opened bottles in the refrigerator. Keep the bottle tightly closed when not in use.

When you open the bottle, write the date on the bottle. Throw away any unused tablets 1 month (30 days) after the date of opening, or if the expiration date printed on the label has passed.

What happens if I miss a dose?

Take the missed dose as soon as you remember, but only if you are getting ready to eat a meal. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

If you skip a meal, do not take your dose of carglumic acid. Wait until your next meal.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include fever, heavy sweating, fast heart rate, coughing up mucus, and feeling restless.

What should I avoid while taking carglumic acid?

Avoid eating foods that are high in protein when you first start taking carglumic acid.

Follow your doctor's instructions about any other restrictions on food, beverages, or activity.

Carglumic acid side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

fever, chills, body aches, flu symptoms, sores in your mouth and throat;

pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or

pain or fullness in your ear, hearing problems.

Less serious side effects may include:

vomiting, diarrhea, stomach pain;

headache; or

stuffy nose, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect carglumic acid?

There may be other drugs that can interact with carglumic acid. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

More Carbaglu resources

Carbaglu Side Effects (in more detail)
Carbaglu Use in Pregnancy & Breastfeeding
Carbaglu Support Group
0 Reviews for Carbaglu - Add your own review/rating

Carbaglu Consumer Overview

Carbaglu MedFacts Consumer Leaflet (Wolters Kluwer)

Carbaglu Prescribing Information (FDA)

carglumic acid Advanced Consumer (Micromedex) - Includes Dosage Information

Carglumic Acid Professional Patient Advice (Wolters Kluwer)

Compare Carbaglu with other medications

Hyperammonemia

Where can I get more information?

Your pharmacist can provide more information about carglumic acid.

See also: Carbaglu side effects (in more detail)

Carbachol

Class: Miotics
ATC Class: S01EB02
VA Class: OP102
CAS Number: 51-83-2
Brands: Miostat, Isopto Carbachol

Introduction

Miotic; direct-acting parasympathomimetic agent.^a ^b ^c ^d

Uses for Carbachol

Open-Angle Glaucoma

Reduction of elevated intraocular pressure (IOP) in patients with primary, open-angle (chronic simple, noncongestive) glaucoma.^c ^d

Used mainly in patients refractory or hypersensitive to pilocarpine.^d

May use concomitantly with sympathomimetic agents, β-adrenergic blocking agents, or carbonic anhydrase inhibitors.^d

Ocular Surgery

Production of miosis during surgery on the anterior chamber of the eye (e.g., cataract extraction, keratoplasty, peripheral iridectomy, cyclodialysis).^b ^d

Reduction of the intensity of IOP elevation for the first 24 hours after cataract surgery.^b

Intraocular acetylcholine generally preferred.^d

Angle-Closure Glaucoma

Reduction of IOP in the emergency treatment of acute (congestive) angle-closure glaucoma† prior to surgery.^d

Pilocarpine generally preferred.^d

Ophthalmologic Examinations

Production of miosis to counteract mydriatic effects of sympathomimetic agents (e.g., hydroxyamphetamine, phenylephrine) after ophthalmoscopic examinations† in glaucoma patients.^d

Pilocarpine generally preferred.^d

Carbachol Dosage and Administration

Administration

Ophthalmic Administration

Administer ophthalmic topical solution to the conjunctival sac; do not inject.^a ^c ^d

Administer intraocular injection by injection into the anterior chamber.^a ^d

Topical Solution

Remove contact lenses before instilling solution.^c ^d

To minimize adverse effects, begin with a low concentration and increase gradually as needed.^d Additionally, instill daily dose or one of the daily doses at bedtime.^d

Following topical instillation, apply finger pressure on the lacrimal sac for 1–2 minutes to minimize drainage into nose and throat and reduce risk of absorption and systemic reactions.^a ^d Remove excess solution around the eye with a tissue and rinse off any medication on hands immediately.^a ^d

Intraocular Injection

Instill into anterior chamber of the eye before or after securing sutures, following the manufacturer’s directions.^b Vials are for single-dose use only; discard unused portion.^a ^b

Dosage

Adjust concentration and frequency of solution instillation according to patient requirements and response, as determined by tonometric readings before and during therapy.^a ^d

In patients with heavily pigmented irides, higher solution concentrations may be required.^d

Adults

Open-Angle Glaucoma

Ophthalmic Topical

1–2 drops of 1.5–3% topical solution up to 3 times daily.^c

Ocular Surgery

Intraocular

Inject ≤0.5 mL of a 0.01% solution.^a ^b

Prescribing Limits

Adults

Ocular Surgery

Intraocular

Maximum: 0.5 mL of a 0.01% injection.^b

Special Populations

No special population dosage recommendations at this time.

Cautions for Carbachol

Contraindications

Known hypersensitivity to carbachol or any ingredient in the formulation.^a ^b ^c ^d

Conditions in which pupillary constriction is undesirable (e.g. acute iritis, pupillary block).^c ^d

Warnings/Precautions

Warnings

Systemic Toxicity

Systemic reactions (e.g., salivation, syncope, cardiac arrhythmia, epigastric distress, headache, vomiting, asthma, hypotension, diarrhea, urinary urgency, increased sweating) reported rarely after topical application or intraocular injection; usually occur only with very frequent administration.^b ^c ^d

Use cautiously in patients with acute cardiac failure, bronchial asthma, active peptic ulcer, hyperthyroidism, GI spasm, urinary tract obstruction, Parkinson’s disease, recent MI, or systemic hypertension or hypotension.^b ^c ^d

Use topical solution cautiously in presence of corneal abrasion to avoid excessive penetration and systemic toxicity.^c ^d

If systemic symptoms occur, discontinue drug, at least temporarily.^d

Ocular Toxicities

Retinal detachment reported rarely; use with extreme caution, if at all, in patients with a history or risk of retinal detachment, especially if young or aphakic.^c ^d Carefully examine retinal periphery at least annually to detect an impending detachment.^d

Intraocular injection: Corneal clouding, persistent bullous keratopathy, retinal detachment, and postoperative iritis reported following cataract extraction in some patients.^a ^b

Sensitivity Reactions

Hypersensitivity

Allergic conjunctivitis, dermatitis, or keratitis reported occasionally with miotics; usually alleviated by changing to another miotic.^d In some instances, allergic reactions may be caused by preservatives in the preparations.^d

Discontinue the drug if sensitivity develops or if original irritation persists or increases.^d

General Precautions

Ocular Effects (Topical Solution)

Possible spasm of accommodation and poor vision in dim light, particularly in geriatric patients and patients with lens opacities.^c ^d (See Advice to Patients.)

Adverse effects often subside after first few days of therapy or if drug is temporarily discontinued.^d (See Administration under Dosage and Administration.)

Possible transient increase in IOP even when the angle is open.^d In some patients with angle-closure glaucoma receiving miotics, may increase IOP and precipitate acute attacks.^d

Possible lens opacities and cataracts; lens opacities may regress if therapy discontinued early in development; however, cataracts are often progressive.^d

Regular slit-lamp examinations recommended; discontinue therapy, at least temporarily, if iris cysts, iritis, synechiae, or lens opacities occur. ^d

Specific Populations

Pregnancy

Category C.^b ^c

Lactation

Not known whether carbachol is distributed into milk.^b ^c ^d Use with caution. ^b ^c

Pediatric Use

Safety and efficacy not established.^b ^c ^d

Geriatric Use

Reduced visual acuity in dim light is common in geriatric patients.^c ^d (See Ocular Effects [Topical Solution] under Cautions.)

Common Adverse Effects

Topical solution: Ocular irritation (burning or discomfort), lacrimation, temporal or periorbital headache, painful ciliary or accommodative spasm, blurred vision or myopia, conjunctival vascular congestion, poor vision in dim light.^c ^d

Interactions for Carbachol

Specific Drugs

Drug	Interaction	Comments
Miotics, anticholinesterase	Possible antagonism^d	Concomitant use of miotics not recommended; unresponsiveness to both drugs may develop^d Increased risk of allergic reactions and toxicity^d
Ocular hypotensive agents (e.g., carbonic anhydrase inhibitors, topical epinephrine, topical timolol)	Additive IOP lowering effects^d	Used to therapeutic advantage^d

Carbachol Pharmacokinetics

Absorption

Bioavailability

Topical carbachol penetrates intact corneal epithelium very poorly; penetration greatly improved in combination with wetting agent (e.g., benzalkonium chloride 0.003%).^d

May be absorbed through intact skin.^d

Onset

Topical solution: Miosis occurs within 10–20 minutes; maximal reduction in IOP occurs within 4 hours.^a

Intraocular injection: Maximal miosis occurs within 2–5 minutes.^a ^b

Duration

Topical solution: Miosis persists for 4–8 hours; reduced IOP persists for approximately 8 hours (3% solution has a slightly longer duration of action than lower concentrations).^a

Intraocular injection: Miosis persists for about 24 hours.^a

Stability

Storage

Ophthalmic

Topical Solution

8–27°C.^c

Intraocular Injection

15–30°C; protect from freezing and excessive heat.^a ^b Stable for 18 months after the date of manufacture.^a

ActionsActions

Choline ester; structurally related to acetylcholine.^a

Directly stimulates cholinergic receptors, resulting in muscarinic and nicotinic effects.^c ^d

Indirectly inhibits cholinesterase activity.^c Resistant to hydrolysis by cholinesterases.^c

May increase release of acetylcholine following nerve stimulation.^d

Contracts the iris sphincter and the ciliary muscle, which produces constriction of the pupil (miosis) and spasm of accommodation, respectively.^b ^d

Reduces IOP in normal and glaucomatous eyes.^d

Exact mechanism for lowering IOP is not precisely known.^b ^d

Facilitates aqueous humor outflow by contracting the ciliary muscle and widening the trabecular meshwork.^d

Decreases activity of extraocular muscles of convergence and causes vasodilation of blood vessels of the conjunctiva, iris, and ciliary body and increased permeability of the blood-aqueous barrier, which may lead to vascular congestion and ocular inflammation.^d

Systemically absorbed carbachol produces parasympathomimetic effects on various body systems.^d (See Systemic Toxicity under Cautions.)

Advice to Patients

Importance of removing contact lenses prior to administering topical solution.^c ^d

Importance of not touching dropper tip to any surface in order to avoid contamination.^c

Advise patient to immediately contact clinician if signs or symptoms of an ocular infection occur.^d

Importance of using caution in night driving or other hazardous tasks in poor light.^c ^d

Importance of instilling daily dose or one of daily doses at bedtime to minimize adverse ocular effects.^d

Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.^d

Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^d

Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Carbachol
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Bulk	Powder
Ophthalmic	Injection, for intraocular use only	100 mcg/mL (0.01%)	Miostat Intraocular	Alcon
	Solution*	1.5%	Isopto Carbachol (with benzalkonium chloride; viscous)	Alcon
		3%*	Isopto Carbachol (with benzalkonium chloride; viscous)	Alcon

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions May 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

a. AHFS Drug Information 2008. McEvoy GK, ed. Carbachol. Bethesda, MD: American Society of Health-System Pharmacists; 2008:2944-5.

b. Alcon Laboratories, Inc. Miostat (carbachol intraocular solution, USP) prescribing information. Fort Worth, TX; 2003 Dec. From website . Accessed 2007 Sept 20.

c. Alcon Laboratories, Inc. Isopto carbachol (carbachol ophthalmic solution) prescribing information. Fort Worth, TX; 2003 Sept.

d. AHFS Drug Information 2008. McEvoy GK, ed. Miotics general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2008:2940-3.

More Carbachol resources

Carbachol Side Effects (in more detail)
Carbachol Use in Pregnancy & Breastfeeding
Carbachol Drug Interactions
Carbachol Support Group
0 Reviews for Carbachol - Add your own review/rating

Compare Carbachol with other medications

Glaucoma
Intraocular Hypertension
Production of Miosis

Colace

Pronunciation: DOK-yoo-sate
Generic Name: Docusate
Brand Name: Examples include Colace and Surfak

Colace is used for:

Relieving occasional constipation and preventing dry, hard stools. It may also be used for other conditions as determined by your doctor.

Colace is a stool softener. It works by helping fat and water into the stool mass to soften the stool.

Do NOT use Colace if:

you are allergic to any ingredient in Colace

you have undiagnosed abdominal pain, nausea, vomiting, or appendicitis

Contact your doctor or health care provider right away if any of these apply to you.

Before using Colace:

Some medical conditions may interact with Colace. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding

if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

if you have allergies to medicines, foods, or other substances

if you have a history of bowel obstruction

if you have nausea, vomiting, stomach pain, or rectal bleeding

Some MEDICINES MAY INTERACT with Colace. Tell your health care provider if you are taking any other medicines, especially any of the following:

Mineral oil because its absorption may be increased

This may not be a complete list of all interactions that may occur. Ask your health care provider if Colace may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Colace:

Use Colace as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take Colace by mouth with or without food.

Take Colace with a full glass of water (8 oz/240 mL).

Drinking extra fluids while you are taking Colace is recommended. Check with your doctor for instructions.

A bowel movement usually occurs 1 to 3 days after the first dose.

If you miss a dose of Colace and are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Colace.

Important safety information:

The risk of loss of normal bowel function may be greater if you take Colace in high doses or for a long time. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.

If your symptoms do not get better within 1 week or if they get worse, check with your doctor.

Check with your doctor if you do not have a bowel movement or if you have rectal bleeding after using Colace.

Do not take Colace with other laxatives or stool softeners, unless directed by your doctor.

Do not use Colace if you experience stomach pain, nausea, vomiting, or rectal bleeding, except under the direction of your doctor.

If you notice a sudden change in bowel movements that lasts for 2 weeks or more, check with your doctor.

Check with your doctor before using Colace in CHILDREN.

PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Colace while you are pregnant. It is not known if Colace is found in breast milk. If you are or will be breast-feeding while you use Colace, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Colace:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Bitter taste; bloating; cramping; diarrhea; gas; irritation around the rectum; throat irritation.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue) fainting; nausea; vomiting.

See also: Colace side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include severe or persistent diarrhea; stomach cramps.

Proper storage of Colace:

Store Colace at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep in a tight, light-resistant container. Keep Colace out of the reach of children and away from pets.

General information:

If you have any questions about Colace, please talk with your doctor, pharmacist, or other health care provider.

Colace is to be used only by the patient for whom it is prescribed. Do not share it with other people.

If your symptoms do not improve or if they become worse, check with your doctor.

Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Colace. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

More Colace resources

Colace Side Effects (in more detail)
Colace Use in Pregnancy & Breastfeeding
Drug Images
Colace Drug Interactions
Colace Support Group
2 Reviews for Colace - Add your own review/rating

Colace Concise Consumer Information (Cerner Multum)

Docusate Professional Patient Advice (Wolters Kluwer)

Aqualax Concise Consumer Information (Cerner Multum)

Docusate Salts Monograph (AHFS DI)

Dostinex Monograph (AHFS DI)

Compare Colace with other medications

Constipation

Cognex

Generic Name: tacrine (Oral route)

tak-reen

Commonly used brand name(s)

In the U.S.

Cognex

Available Dosage Forms:

Capsule

Therapeutic Class: Central Nervous System Agent

Pharmacologic Class: Cholinesterase Inhibitor, Centrally Acting

Uses For Cognex

Tacrine is used to treat the symptoms of mild to moderate Alzheimer's disease. Tacrine will not cure Alzheimer's disease, and it will not stop the disease from getting worse. However, tacrine can improve thinking ability in some patients with Alzheimer's disease.

In Alzheimer's disease, many chemical changes take place in the brain. One of the earliest and biggest changes is that there is less of a chemical messenger called acetylcholine (ACh). ACh helps the brain to work properly. Tacrine slows the breakdown of ACh, so it can build up and have a greater effect. However, as Alzheimer's disease gets worse, there will be less and less ACh, so tacrine may not work as well.

Tacrine may cause liver problems. While taking this medicine, you must have blood tests regularly to see if the medicine is affecting your liver.

This medicine is available only with your doctor's prescription.

Before Using Cognex

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of tacrine in children with use in other age groups.

Geriatric

Studies on tacrine have been done only in middle-aged and older patients. Information on the effects of tacrine is based on these patients.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Estradiol

Fluvoxamine

Haloperidol

Ibuprofen

Levonorgestrel

Riluzole

Theophylline

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use of Cognex

Take this medicine only as directed by your doctor. Do not take more or less of it, and do not take it more or less often than your doctor ordered. Taking too much may increase the chance of side effects, while taking too little may not improve your condition.

Tacrine is best taken on an empty stomach (1 hour before or 2 hours after meals). However, if this medicine upsets your stomach, your doctor may want you to take it with food.

Tacrine seems to work best when it is taken at regularly spaced times, usually four times a day.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (capsules):
- For treatment of Alzheimer's disease:
  - Adults—To start, 10 milligrams (mg) four times a day. Your doctor may increase your dose gradually if you are doing well on this medicine and your liver tests are normal. However, the dose is usually not more than 40 mg four times a day.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using Cognex

It is important that your doctor check your progress at regular visits. Also, you must have your blood tested every other week for at least the first 4 to 16 weeks when you start using tacrine to see if this medicine is affecting your liver. If all of the blood tests are normal, you will still need regular testing, but then your doctor may decide to do the tests less often.

Tell your doctor if your symptoms get worse, or if you notice any new symptoms.

Before you have any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine. Taking tacrine together with medicines that are sometimes used during surgery or dental or emergency treatments may increase the effects of these medicines.

Tacrine may cause some people to become dizzy, clumsy, or unsteady. Make sure you know how you react to this medicine before you do anything that could be dangerous if you are dizzy, clumsy, or unsteady.

Do not stop taking this medicine or decrease your dose without first checking with your doctor. Stopping this medicine suddenly or decreasing the dose by a large amount may cause mental or behavior changes.

If you think you or someone else may have taken an overdose of tacrine, get emergency help at once. Taking an overdose of tacrine may lead to seizures or shock. Some signs of shock are large pupils, irregular breathing, and fast weak pulse. Other signs of an overdose are severe nausea and vomiting, increasing muscle weakness, greatly increased sweating, and greatly increased watering of the mouth.

Cognex Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Some side effects will have signs or symptoms that you can see or feel. Your doctor may watch for others by doing certain tests

Tacrine may cause some serious side effects, including liver problems. You and your doctor should discuss the good this medicine will do as well as the risks of receiving it.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

Clumsiness or unsteadiness

diarrhea

loss of appetite

nausea

vomiting

Less common

Fainting

fast or pounding heartbeat

fever

high or low blood pressure

skin rash

slow heartbeat

Rare

Aggression, irritability, or nervousness

change in stool color

convulsions (seizures)

cough, tightness in chest, troubled breathing, or wheezing

stiffness of arms or legs, slow movement, or trembling and shaking of hands and fingers

trouble in urinating

yellow eyes or skin

Symptoms of overdose

Convulsions (seizures)

greatly increased sweating

greatly increased watering of mouth

increasing muscle weakness

low blood pressure

nausea (severe)

shock (fast weak pulse, irregular breathing, large pupils)

slow heartbeat

vomiting (severe)

This medicine may also cause the following side effect that your doctor will watch for:

More common

Liver problems

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Abdominal or stomach pain or cramping

dizziness

headache

indigestion

muscle aches or pain

Less common

Belching

fast breathing

flushing of skin

general feeling of discomfort or illness

increased sweating

increased urination

increased watering of eyes

increased watering of mouth

runny nose

swelling of feet or lower legs

trouble in sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Cognex side effects (in more detail)

The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

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More Cognex resources

Cognex Side Effects (in more detail)
Cognex Dosage
Cognex Use in Pregnancy & Breastfeeding
Drug Images
Cognex Drug Interactions
Cognex Support Group
0 Reviews for Cognex - Add your own review/rating

Cognex Prescribing Information (FDA)

Cognex Concise Consumer Information (Cerner Multum)

Cognex Monograph (AHFS DI)

Cognex MedFacts Consumer Leaflet (Wolters Kluwer)

Compare Cognex with other medications

Alzheimer's Disease

Cognex

Generic Name: Tacrine Hydrochloride
Class: Parasympathomimetic (Cholinergic) Agents
VA Class: AU300
Chemical Name: 9-Acridinamine, 1,2,3,4-tetrahydro-,monohydrochloride
CAS Number: 1684-40-8

Introduction

Centrally active, reversible anticholinesterase agent.² ³ ⁴ ⁵ ⁶ ¹²

Uses for Cognex

Alzheimer’s Disease

Palliative treatment of mild to moderate dementia of the Alzheimer’s type (Alzheimer’s disease, presenile or senile dementia).¹ ³ ⁵ ¹² ¹³ ¹⁴ ¹⁵ ¹⁶ ¹⁷ ¹⁸ ²⁴ ⁴⁶ ⁴⁷ ⁵³

Cognex Dosage and Administration

General

Carefully adjust dose according to individual response and tolerance (e.g., serum ALT concentrations).¹

Observe for adverse effects following initiation of therapy or an increase in dosage.¹ ⁴⁶ ⁴⁷ ⁴⁸

Monitoring of ALT concentrations needed; adjustment in the treatment regimen may be needed in patients with ALT elevations.¹

Liver Function Monitoring

Monitor serum ALT concentrations every other week from at least week 4 to week 16 and every 3 months thereafter.¹

If serum ALT concentrations are >2 times to ≤3 times the ULN, monitor weekly until serum concentrations return to within normal limits.¹

If serum ALT concentrations are >3 times to ≤5 times the ULN, reduce dosage and monitor weekly until serum concentrations return to within normal limits.¹

If serum ALT concentrations are >5 times the ULN, discontinue therapy, at least temporarily, and monitor until serum concentrations return to normal.¹

During rechallenge, monitor ALT concentrations every week for 16 weeks, every month for 2 months, then every 3 months thereafter.¹

Administration

Administer orally¹ ¹² ¹³ ¹⁴ ¹⁵ ¹⁶ ¹⁷ ²⁵ ²⁷ ²⁸ between (i.e., ≥1 hour before) meals whenever possible.¹ ⁵³ (See Food under Pharmacokinetics.) If mild GI upset occurs, administer with meals.¹ ⁵³

Therapy should be initiated using a low dosage for the first 4 weeks.¹ Increase dosage based on response and tolerance.¹

Do not attempt dosage escalation during initial 4-week period due to possible delayed-onset liver function abnormalities.¹ Decrease rate of dosage escalation if patient does not tolerate the recommended titration schedule; acceleration of recommended schedule is not advisable.¹

Administer highest tolerated dosage; cognitive improvement is more likely to occur at higher dosages.⁴⁶ Discontinue therapy if there is no improvement in clinical status after 3–6 months.⁴⁶

Dosage adjustment or temporary discontinuance may be necessary in patients with serum ALT elevations.¹

If tacrine therapy is interrupted for >4 weeks and reinitiation of the drug is not contraindicated, resume therapy using the lowest dosage and titrate upward.¹

Rechallenge

When therapy is withheld due to elevated serum ALT concentrations, rechallenge with the drug when ALT concentrations have returned to within normal limits.¹

Rechallenge in patients with elevations <10 times the ULN not associated with serious hepatic injury.¹

Carefully weigh risks against the possible benefits in patients with elevations >10 times the ULN.¹

Elevations in ALT concentrations (≥3 times the ULN) reported in patients who are rechallenged; time to onset of such elevations may be more rapid than with initial therapy.¹

Dosage

Available as tacrine hydrochloride; dosage expressed in terms of tacrine.¹

Adjust dosage or discontinue therapy in patients with serum ALT elevations as required.¹ ⁵³

Adults

Alzheimer’s Disease

Initiation and Titration

Oral

Initially, 10 mg 4 times daily for at least 4 weeks.¹ ⁴⁶ ⁴⁷ ⁵³

If well tolerated and increased serum ALT concentrations have not occurred, increase dosage to 20 mg 4 times daily;¹ if tolerated, increase dosage in 40-mg daily increments (divided into 4 doses daily) at 4-week intervals¹ up to a maximum of 160 mg daily (40 mg 4 times daily).¹ ⁴⁶ ⁴⁷

Dosage Adjustment for ALT Elevations

Oral

If serum ALT concentrations are ≤3 times the ULN, continue usual dosages.¹

If serum ALT concentrations are >3 times to ≤5 times the ULN, reduce dosage by 40 mg daily.¹ Resume usual dosages when ALT concentrations have returned to within normal limits.¹

If serum ALT concentrations are >5 times the ULN, withhold tacrine.¹ Consider rechallenge when ALT concentrations have returned to within normal limits.¹

Rechallenge

Oral

Initially, 10 mg 4 times daily for at least 6 weeks.¹ If tolerated with no unacceptable changes in serum ALT concentrations, resume recommended dosage titration schedule.¹

Prescribing Limits

Adults

Alzheimer’s Disease

Oral

Maximum 160 mg daily (40 mg 4 times daily).¹ ⁴⁶ ⁴⁷

Special Populations

Hepatic Impairment

Reduced clearance is likely; dosage adjustments should be considered.¹ ^b (See Hepatic Impairment under Cautions.)

Cautions for Cognex

Contraindications

Known hypersensitivity to tacrine or acridine derivatives.¹

Jaundice, serum total bilirubin concentration >3 mg/dL, and/or clinical signs and/or symptoms of hypersensitivity (e.g., rash, fever) associated with elevations of ALT attributed to tacrine.¹

Warnings/Precautions

Warnings

Permanently discontinue therapy in patients with clinical evidence of jaundice confirmed by elevations in serum total bilirubin concentration >3 mg/dL and/or clinical signs and/or symptoms of hypersensitivity (e.g., rash, fever) associated with elevations of ALT; do not rechallenge with the drug.¹

Anesthesia

Potential for exaggerated succinylcholine-type muscle relaxation during anesthesia.¹

Cardiovascular Effects

Possible bradycardia or other vagotonic effects on the heart.^a Use with caution in patients with conduction abnormalities, bradyarrhythmias, or sick sinus syndrome.^a

GI Effects

Possible diarrhea, nausea, and vomiting at recommended dosages.¹

Potential for increased gastric acid secretion.¹

Carefully monitor patients, especially those at increased risk for developing ulcers (e.g., those with history of peptic ulcer disease, those receiving concomitant NSAIA therapy), for symptoms of active or occult GI disease.¹

Hepatic Effects

Increased serum ALT concentrations reported in >50% of patients receiving tacrine.¹ ³⁷ Risk of increased ALT higher in women than men.¹ ³⁷ Serum ALT concentrations return to normal following discontinuance or dosage reduction.¹ ³⁷ Clinically evident hepatic injury occurs rarely.¹ ³¹ (See Hepatic Impairment under Cautions.)

Frequent monitoring of ALT needed.¹ (See Liver Function Monitoring under Dosage and Administration.)

GU Effects

Potential urinary obstruction secondary to cholinergic activity.¹

Nervous System Effects

Possible increased risk of seizures secondary to cholinergic activity or possibly as a manifestation of Alzheimer’s disease.¹

Abrupt discontinuance or rapid dosage reduction (e.g., by ≥80 mg daily) may result in sudden worsening of the degree of cognitive impairment.¹

Respiratory Effects

Use with caution in patients with a history of asthma.¹

General Precautions

Hematologic Effects

Possible decreased ANC; however, serious hematologic abnormalities attributable to tacrine not reported.¹

Specific Populations

Pregnancy

Category C.¹

Lactation

Not known whether tacrine is distributed into milk.¹

Pediatric Use

Safety and efficacy not established.¹ ³¹

Hepatic Impairment

Possible reduced clearance.¹

Use with caution in patients with current evidence or history of liver function abnormalities (i.e., clinically important elevations in serum ALT, AST, bilirubin, and/or γ-glutamyltransferase [γ-glutamyltranspeptidase, GT, GGTP]).¹ ³¹ ³² ⁴⁸ Discontinue therapy, at least temporarily, if ALT concentrations are >5 times the ULN.¹

Renal Impairment

Possible fluid and electrolyte disturbances resulting from adverse GI effects.³² Use with caution.³²

Common Adverse Effects

Elevated aminotransferases (ALT, AST), nausea, vomiting, diarrhea, anorexia, dyspepsia, myalgia, ataxia.¹

Interactions for Cognex

Metabolized primarily by CYP1A2.¹ Dosage adjustments may be necessary with concomitant administration of drugs that affect or are metabolized by this system.¹ ⁵³

Drugs Affecting or Metabolized by Hepatic Microsomal Enzymes

Potential pharmacokinetic interaction with drugs metabolized by CYP1A2.¹ ⁵³

Smoking

Pharmacokinetic interaction (decreased tacrine concentrations).¹

Specific Drugs

Drug	Interaction	Comments
Antacids (magnesium- or aluminum-containing)	Change in tacrine bioavailability unlikely¹
Anticholinergic agents	Possible interference with activity of anticholinergic agents¹
Cholinergic agonists	Synergistic effect¹
Cholinesterase inhibitors	Synergistic effect¹
Cimetidine	Increased tacrine concentrations and AUC¹
Diazepam	Pharmacokinetic interaction unlikely¹
Digoxin	Pharmacokinetic interaction unlikely¹
Fluvoxamine	Increased tacrine concentrations and AUC^a
Neuromuscular blocking agents (e.g., succinylcholine)	Exaggerated muscle relaxation¹
Theophylline	Increased theophylline elimination half-life and theophylline concentrations¹	Monitor plasma theophylline concentrations and adjust theophylline dosage as required¹
Warfarin	Effect on anticoagulant activity unlikely¹

Cognex Pharmacokinetics

Absorption

Bioavailability

Rapidly absorbed following oral administration; undergoes dose-dependent, first-pass metabolism.¹ Absolute bioavailability is approximately 17%.¹

Peak plasma concentrations are attained in 1–2 hours.¹ Plasma concentrations are approximately 50% higher in women than men.¹

Food

Food reduces bioavailability by approximately 30–40%.¹

Distribution

Extent

Not evaluated.¹

Not known whether tacrine is distributed into milk.¹

Plasma Protein Binding

About 55%.¹

Elimination

Metabolism

Extensively metabolized, principally via CYP1A2 to multiple metabolites.¹

Elimination Route

Not known whether tacrine undergoes biliary excretion or enterohepatic circulation.¹

Half-life

2–4 hours.¹

Special Populations

Pharmacokinetics not evaluated in patients with hepatic impairment to date; however, clearance may be reduced.¹ Clearance not altered in patients with renal impairment.¹

Stability

Storage

Oral

Capsules

15–30°C. Protect from moisture.¹

ActionsActions

Precise mechanism(s) of action in patients with dementia of the Alzheimer’s type not fully elucidated.¹ Binds reversibly with and inactivates cholinesterases (e.g., acetylcholinesterase), thus inhibiting hydrolysis of acetylcholine¹ ⁴ ⁵ ⁶ ⁷ ¹³ and resulting in increased acetylcholine concentrations at cholinergic synapses.¹ ⁴ ⁵ ⁶ ⁷

Advice to Patients

Risk of adverse effects (e.g., nausea, vomiting, loose stools, diarrhea).¹ Importance of caregivers monitoring for adverse effects and informing clinicians if they occur.¹

Importance of clinicians informing caregivers that potential beneficial effects of therapy depend on administration of the drug at regular intervals.¹

Need for periodic laboratory monitoring (i.e., liver function tests).¹

Importance of clinicians informing caregivers that abrupt discontinuation or large decrease in total daily dose may cause a sudden worsening of the degree of cognitive impairment.¹

Importance of informing clinicians of any new events or any increase in severity of existing adverse clinical events.¹

Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.¹

Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹

Importance of informing patients of other important precautionary information.¹ (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Tacrine Hydrochloride
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Capsules	10 mg (of tacrine)	Cognex	First Horizon
		20 mg (of tacrine)	Cognex	First Horizon
		30 mg (of tacrine)	Cognex	First Horizon
		40 mg (of tacrine)	Cognex	First Horizon

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Cognex 10MG Capsules (SHIONOGI PHARMA): 120/$315.99 or 360/$893.99

Cognex 20MG Capsules (SHIONOGI PHARMA): 120/$315.99 or 360/$879.92

Disclaimer

References

1. Parke-Davis. Cognex (tacrine hydrochloride) capsules prescribing information. Morris Plains, NJ; 1997 Oct.

2. Parke-Davis. Cognex treatment IND investigator’s brochure. Morris Plains, NJ; 1992.

3. Cooper JK. Drug treatment of Alzheimer’s disease. Arch Intern Med. 1991; 151:245-9. [IDIS 277908] [PubMed 1992951]

4. Kumar V, Becker RE. Clinical pharmacology of tetrahydroaminoacridine: a possible therapeutic agent for Alzheimer’s disease. Int J Clin Pharmacol Ther Toxicol. 1989; 27:478-85. [PubMed 2684868]

5. Volger BW. Alternatives in the treatment of memory loss in patients with Alzheimer’s disease. Clin Pharm. 1991; 10:447-56. [IDIS 281504] [PubMed 2065522]

6. Freeman SE, Dawson RM. Tacrine: a pharmacological review. Prog Neurobiol. 1991; 36:257-77. [PubMed 1714613]

7. Drukarch B, Kits KS, Van der Meer EG et al. 9-Amino-1,2,3,4-tetrahydroacridine (THA), an alleged drug for the treatment of Alzheimer’s disease, inhibits acetylcholinesterase activity and slow outward K⁺current. Eur J Pharmacol. 1987; 141:153-7. [PubMed 2444444]

8. Rogawski MA. Tetrahydroaminoacridine blocks voltage-dependent ion channels in hippocampal neurons. Eur J Pharmacol. 1987; 142:169-72. [PubMed 2446884]

9. Freeman SE, Law WM, Szilagyi M. Blockade of a cardiac K⁺ channel by tacrine: interactions with muscarinic and adenosine receptors. Eur J Pharmacol. 1988; 154:59-65. [PubMed 3181293]

10. Mozar HN, Bal DG, Howard JT. Perspectives on the etiology of Alzheimer’s disease. JAMA. 1987; 257:1503-7. [PubMed 2950247]

11. Parke-Davis, Morris Plains, NJ: Personal communication.

12. Parke-Davis. Cognex treatment IND protocol 970-58. Morris Plains, NJ; 1992.

13. Farlow M, Gracon SI, Hershey LA et al. A controlled trial of tacrine in Alzheimer’s disease. JAMA. 1992; 268:2523-9. [IDIS 304558] [PubMed 1404819]

14. Davis KL, Thal LJ, Gamzu ER et al. A double-blind, placebo-controlled multicenter study of tacrine for Alzheimer’s disease. New Engl J Med. 1992; 327:1253-9. [IDIS 303816] [PubMed 1406817]

15. Peripheral and Central Nervous System Drugs Advisory Committee Meeting, July 7, 1989. Rockville, MD: Dept. of Health and Human Services, Public Health Service, Food and Drug Administration; 1989:227.

16. Eagger SA, Levy R, Sahakian BJ. Tacrine in Alzheimer’s disease. Lancet. 1991; 337:989-92. [IDIS 280218] [PubMed 1673209]

17. Anon. Tacrine for Alzheimer’s disease. Med Lett Drugs Ther. 1993; 35:87-8. [PubMed 8361451]

18. Small GW. Tacrine for treating Alzheimer’s disease. JAMA. 1992; 268:2564-5. [IDIS 304559] [PubMed 1404825]

19. Dom R. Tacrine in Alzheimer’s disease. JAMA. 1993; 269:2848-9. [IDIS 315101] [PubMed 8497088]

20. Cutler NR, Sramek JJ. Tacrine in Alzheimer’s disease. New Engl J Med. 1993; 328:808. [IDIS 310606] [PubMed 8437603]

21. Growdon JH. Treatment for Alzheimer’s disease? New Engl J Med. 1992; 327:1306-8. Editorial.

22. Pirozzolo FJ, Baskin DS, Swihart AA et al. Oral tetrahydroaminoacridine in the treatment of senile dementia, Alzheimer’s type. New Engl J Med. 1987; 316:1603. [IDIS 230804] [PubMed 3587295]

23. Lachs M. Tacrine in Alzheimer’s disease. New Engl J Med. 1993; 328:810. [IDIS 310609] [PubMed 8437607]

24. Food and Drug Administration Division of Neuropharmacological Drug Products. Tacrine as a treatment for Alzheimer’s dementia: an interim report from the FDA. N Engl J Med. 1991; 324:349-52. [IDIS 277140] [PubMed 1986300]

25. Summers WK, Majovski LV, Marsh GM et al. Oral tetrahydroaminoacridine in long-term treatment of senile dementia, Alzheimer type. N Engl J Med. 1986; 315:1241-5. [IDIS 222579] [PubMed 2430180]

26. Relman AS. Tacrine as a treatment for Alzheimer’s dementia: editor’s note. N Engl J Med. 1991; 324:349. [IDIS 277140] [PubMed 1986300]

27. Gauthier S, Bouchard R, Lamontagne A et al. Tetrahydroaminoacridine–lecithin combination treatment in patients with intermediate-stage Alzheimer’s disease: results of a Canadian double-blind, cross-over, multicenter study. N Engl J Med. 1990; 322:1272-6. [IDIS 265329] [PubMed 2183056]

28. Chatellier G, Lacombez L, and Groupe Francais d’Etude de la Tetrahydroaminoacridine. Tacrine (tetrahydroaminoacridine; THA) and lecithin in senile dementia of the Alzheimer type: a multicentre trial. Br Med J. 1990; 300:495-9.

29. Ulus IH, Wurtman RJ. Prevention by choline of the depletion of membrane phosphatidylcholine by a cholinesterase inhibitor. N Engl J Med. 1988; 318:191. [PubMed 3336410]

30. Gauthier S. Tetrahydroaminoacridine and lecithin for Alzheimer’s disease. N Engl J Med. 1990; 323:920. [IDIS 272229] [PubMed 1697647]

31. Parke-Davis, Morris Plains, NJ: Personal communication.

32. Reviewers’ comments (personal observations).

33. Osterrieder W. 9-amino-1,2,3,4-tetrahydroacridine (THA) is a potent blocker of cardiac potassium channels. Br J Pharmacol. 1987; 92:521-5. [PubMed 2447986]

34. Schauf CL, Settin A. Tetrahydroaminoacridine blocks potassium channels and inhibits sodium inactivation in Myxicola. Soc Neurosci Abstract. 1987; 13:566.

35. Drukarch B, Kits KS, Vander Meer EG et al. 9-Amino-1,2,3,4-tetrahydroacridine (THA), an alleged drug for the treatment of Alzheimer’s disease, inhibits acetylcholinesterase activity and slows outward K⁺current. Eur J Pharmacol. 1987; 141:153-7. [PubMed 2444444]

36. Knapp MJ, Knopman DS, Soloman PR et al. A 30-week randomized controlled trial of high-dose tacrine in patients with Alzheimer’s disease. JAMA. 1994; 217:985-91.

37. Watkins PB, Zimmerman HJ, Knapp MJ et al. Hepatotoxic effects of tacrine administration in patients with Alzheimer’s disease. JAMA. 1994; 217:992-8.

38. Winker MA. Tacrine for Alzheimer’s disease: which patient, what dose? JAMA. 1994; 271:1023-4. Editorial.

39. Byrne EJ, Arie T. Tetrahydroaminoacridine and Alzheimer’s disease: for the few, but we don’t know which few. BMJ. 1994; 308:868-9. [IDIS 327976] [PubMed 8173360]

40. Maltby N, Broe GA, Creasey H et al. Efficacy of tacrine in mild to moderate Alzheimer’s disease: double blind trial. BMJ. 1994; 308:879-83. [IDIS 327979] [PubMed 8173365]

41. Pendlebury WW, Soloman PR. Tacrine is safe and effective. BMJ. 1994; 308:1506.

42. Levy R. Patient heterogeneity explains varied response. BMJ. 1994; 308:1506. [PubMed 8019288]

43. Roberts C, Ford J, Mäkelä P et al. Serum tacrine concentrations too low. BMJ. 1994; 308:1506.

44. Wilcock GK. Negative conclusions not justified. BMJ. 1994; 308:1507. [PubMed 8019291]

45. Broe GA, Creasey H, Maltby N et al. Author’s reply. BMJ. 1994; 308:1507.

46. American Psychiatric Association. Practice guidelines for the treatment of patients with Alzheimer’s disease and other dementias of late life. Am J Psychiatry. 1997; 154(Suppl):1-39.

47. Small GW, Rabins PV, Barry PP et al. Diagnosis and treatment of Alzheimer disease and related disorders: consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer’s Association, and the American Geriatrics Society. JAMA. 1997; 278:1363-71. [IDIS 393115] [PubMed 9343469]

48. Watkins PB, Zimmerman HJ, Knapp MJ et al. Hepatotoxic effects of tacrine administration in patients with Alzheimer’s disease. JAMA. 1994; 271:992-8. [IDIS 327345] [PubMed 8139084]

49. Mos RC. Donepezil: a viewpoint. Drugs Aging. 1997; 10:240.

50. Whitehouse PJ. Donepezil: a viewpoint. Drugs Aging. 1997; 10:240-1.

51. Solomon PR, Knapp MJ, Gracon SI et al. Long-term tacrine treatment in patients with Alzheimer’s disease. Lancet. 1996; 348:275-6. [IDIS 370167] [PubMed 8684234]

52. Knopman D, Schneider L, Davis K et al. Long-term tacrine (Cognex) treatment: effects on nursing home placement and mortality. Neurology. 1996; 47:166-77. [IDIS 370441] [PubMed 8710072]

53. Samuels SC, Davis KL. A risk-benefit assessment of tacrine in the treatment of Alzheimer’s disease. Drug Saf. 1997; 16:66-77. [PubMed 9010644]

54. Doody Rs, Stevens JC, Beck C et al. Practice parameter: management of dementia (an evidence-based review). Report of the quality standards subcommittee of the American Academy of Neurology. Neurology. 2001; 56:1154-66. [IDIS 463599] [PubMed 11342679]

a. First Horizon. Cognex (tacrine hydrochloride) capsules prescribing information. Roswell, GA; 2002 Jan.

b. AHFS drug information 2006. McEvoy GK, ed. Tacrine. Bethesda, MD: American Society of Health-System Pharmacists; 2006:1251-4

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