Dementia Won't Improve With Procaine, And Health Might Suffer

Main Category: Alzheimer's / Dementia
Also Included In: Clinical Trials / Drug Trials
Article Date: 09 Oct 2008 - 0:00 PDT

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Procaine, a medication that functions as a topical anesthetic normally, has been touted as an anti-aging drug that might prevent or even reverse dementia. However, a new Cochrane Review suggests that the risks of bad side effects outweigh any benefit.

"There is a lot of information, especially on the Internet, about the effect of procaine, promoting this drug for age-related problems, including dementia," said lead author Szabolcs Szatmàri at the University of Medicine and Pharmacy in Romania. "At the same time, there were no available updated medical guidelines or evidence-based data for doctors and patients about procaine."

The review included three studies involving 427 patients. Data from these studies showed high incidence of side effects such as restlessness, dizziness, migraine headaches and systemic lupus erythematosus, a disease in which a person's immune system attacks itself.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The authors found two older studies of healthy elderly persons suggesting that procaine might have a positive effect on memory in those who have no cognitive impairment. A third study, however, showed a worsening effect on people with dementia after one month of procaine treatment.

"There is not enough evidence to recommend procaine compounds for preventing or treating dementia," Szatmàri said. "Using procaine preparations carries some risks, and there are more useful interventions related to cognitive impairment. Yet there is still strong marketing activity despite this lack of evidence of effect and also despite the decision of the Food and Drug Administration in 1982 to prohibit the importation of procaine preparations into the United States."

Procaine preparations are available in more 70 countries and estimates indicate that more than 100 million people might use them. Although officially banned in the United States, offshore Internet pharmacies can provide the compound to American consumers.

"The compound appears to be widely used outside the U.S. as an over-the-counter cognitive enhancer," said Paul Newhouse, M.D., a professor of psychiatry at the University of Vermont College of Medicine. "But there is no evidence that it does anything at all and even some evidence it is toxic. At this point, it cannot be recommended for any use as a cognitive enhancer or a way to treat dementia."

Newhouse, who is also the research director of the Memory Clinic at the university, said he had heard about this use for procaine compounds 25 years ago, but thought it had fallen out of use in the interim. However, the advent of the Internet apparently has renewed interest.

"I guess I shouldn't be surprised since people are trying to sell many different unproven remedies through the Internet," he said.

There is no rational biological reason for procaine to work as a way to enhance cognitive function, Newhouse said.

"Usually, you have to at least come up a plausible theory about why your drug might be useful," he said. "Procaine works to inhibit sodium channels (in the cells) and thus chemically stabilize nerve cells and actually reduces their ability to fire. Why that should have cognitive enhancing effects eludes me."

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Szatmàri S, et al. Procaine treatments for cognition and dementia (Review). Cochrane Database of Systematic Reviews. 2008, Issue 4.

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