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All about: Procyclidine

Big Image Pronouncation: (pro-SIGH-klih-deen)
Class: Anticholinergic

Trade Names:
Kemadrin
- Tablets 5 mg

Procyclid (Canada)

Mechanism of Action

Pharmacology

Has atropine-like action and exerts antispasmodic effect on smooth muscle. Is potent mydriatic and inhibits salivation; normally has no sympathetic ganglion-blocking activity.

Pharmacokinetics

Absorption

Procyclidine HCl is well-absorbed from the GI tract. T max is 1.1 to 2 hr. C max is 80 mcg/L. Bioavailability is 52% to 97% (oral).

Elimination

The t 1/ 2 is 11.5 to 12.6 hr.

Duration

4 hr (oral).

Indications and Usage

Treatment of parkinsonism, including postencephalitic, arteriosclerotic and idiopathic types. Usually more efficacious in relief of rigidity than of tremor and can be used alone in mild to moderate cases. Also can be given to treat drug-induced extrapyramidal symptoms of phenothiazine or rauwolfia therapy and to control sialorrhea associated with neuroleptic medication.

Contraindications

Angleclosure glaucoma; pyloric and duodenal obstruction; stenosing peptic ulcers; prostatic hypertrophy; bladder neck obstruction; achalasia; myasthenia gravis; megacolon.

Dosage and Administration

Parkinsonism (No Prior Therapy)
Adults

PO 2.5 mg tid after meals initially. If well tolerated, dose may be gradually increased to 5 mg tid. Bedtime dose can be added if necessary.

Transferring from Prior Therapy

Substitute 2.5 mg tid for all or part of original agent. Increase prn while other drug is lowered or omitted. Individualize (max dose, 60 mg/day).

Drug-Induced Extrapyramidal Symptoms
Adults

Begin with 2.5 mg tid; increase by 2.5 mg increments until symptoms are relieved. Usually 10 to 20 mg/day is adequate.

General Advice

Give with food if GI upset is experienced.

Storage/Stability

Store at room temperature in tightly closed container.

Drug Interactions

Haloperidol

Schizophrenic symptoms may worsen, haloperidol levels may decrease and tardive dyskinesia may develop.

Phenothiazines

Actions of phenothiazines may be decreased. Anticholinergic side effects may increase.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Tachycardia; palpitations; orthostatic hypotension.

CNS

Disorientation; confusion; memory loss; hallucinations; agitation; nervousness; depression; drowsiness; giddiness; lightheadedness.

Dermatologic

Rash; urticaria; decreased sweating.

EENT

Mydriasis; blurred vision.

GI

Dry mouth; nausea; vomiting; epigastric distress; constipation; paralytic ileus.

Genitourinary

Urinary retention; urinary hesitancy.

Miscellaneous

Muscle weakness; acute suppurative parotitis; hyperthermia; heat stroke.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Elderly

More susceptible to adverse effects. Occasionally may exhibit confusion, disorientation, agitation, hallucinations, and psychotic-like symptoms.

Special Risk Patients

Use caution in concurrent illness in which anticholinergic effects may be undesirable (ie, tachycardia, urinary retention, marked prostatic hypertrophy). Closely observe hypotensive patients.

Anticholinergic effects

Administration of other drugs with anticholinergic effects will increase incidence and severity of these effects.

CNS

Psychotic episode may be precipitated in treating drug-induced extrapyramidal side effects of phenothiazines or rauwolfia derivatives.

Heat illness

Give with caution during hot weather.

Ophthalmic

Incipient narrow-angle glaucoma may be precipitated.

Overdosage

Symptoms

Circulatory collapse, respiratory depression or arrest, CNS depression preceded or followed by stimulation, psychosis, stupor, coma, seizures, fever, hot/dry/flushed skin, dry mucous membranes, paralytic ileus.

Patient Information

  • Advise patient to use caution in hot weather as drug increases susceptibility to heat stroke.
  • Instruct patient to report the following symptoms to health care provider immediately: pounding heartbeat, eye pain, confusion or skin rash. Also tell patient to report bothersome side effects including blurred vision, urinary retention or hesitancy, nausea, vomiting, constipation, dizziness, drowsiness or dry mouth, nose, or throat.
  • Tell patient to take sips of water frequently, suck on ice chips or sugarless hard candy or chew sugarless gum if dry mouth occurs.
  • Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
  • Advise patient that drug may cause drowsiness or dizziness and to use caution while driving or performing tasks requiring mental alertness.
  • Instruct patient not to take any OTC medications without consulting health care provider.

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