Tacrine-Induced Hepatotoxicity: Tolerability and Management

Abstract

Summary Tacrine, a centrally acting, reversible acetylcholinesterase inhibitor, is effective in the treatment of Alzheimer’s disease. However, a major adverse effect of the drug is hepatotoxicity, which affects about one-half of patients treated. The pathogenic mechanisms of this hepatotoxicity are poorly understood, but probably involve reactive metabolites. The liver injury is predominantly that of hepatocellular necrosis, and manifests as an increase in serum alanine aminotransferase (ALT) levels; 25 and 2% of patients will experience ALT levels greater than 3 times and 20 times the upper limit of the normal range, respectively. Although hepatotoxicity is generally asymptomatic and has no..