Idebenone. A review of
its pharmacodynamic and pharmacokinetic properties, and therapeutic use in
age-related cognitive disorders.
Gillis JC, Benefield P, McTavish D.
Adis International Limited,
Auckland, New Zealand.
Drugs Aging 1994 Aug;5(2):133-52
Idebenone is a benzoquinone compound which has been investigated in elderly
patients with dementia. Its precise mechanism(s) of action remains unknown,
but in vitro and in vivo studies suggest the drug may diminish nerve cell
damage due to ischaemia, correct neurotransmitter defects and/or cerebral
metabolism and facilitate memory and learning. In the small number of studies
available for evaluation, idebenone was generally superior to placebo and
comparable with bifemelane, oxiracetam and nebracetam on the basis of a number
of objective and subjective tests and rating scales in patients with mild to
moderate cognitive decline. Clinical trial results indicate that patients with
mild dementia seem more likely to respond than those with greater functional
decline. The degree of benefit conferred by idebenone is often difficult to
determine, but in those who respond, improvement is generally mild to
moderate. Therapy with idebenone appears well tolerated for up to 2 years, and
no changes in vital signs or laboratory values have been seen in clinical
trials. In view of the lack of a proven agent to limit or halt the progression
of dementia in the elderly, idebenone may warrant consideration in patients
with mild cognitive dysfunction on the basis of preliminary evidence of
predominantly mild improvement of functional status in some patients and good
tolerability. However, further well designed studies, including comparisons
with newer and commonly used agents, such as tacrine, are required to better
define the role of idebenone in this complex area of treatment.